Are Bedside Predictors of Difficult Intubation Really True Indicators in Head and Neck Cancer Patients?

Abstract

BACKGROUND Unanticipated difficult airway can lead to serious morbidity and mortality in Head and Neck cancer surgical patients. We wanted to determine the incidence of difficult laryngoscopy, difficult intubation and their correlation with routine bedside predictors of difficult airway. METHODS In this prospective observational study, 30 patients posted for elective oral and neck cancer surgery were assessed preoperatively and history of addiction, previous head and neck chemoradiation therapy, Mallampati grade, inter-incisor distance, thyromental distance and neck movements were noted. After standard anaesthetic induction, Cormack Lehane Grade was noted on first direct laryngoscopy attempt and intubation difficulty was assessed using intubation difficulty scale on the basis of seven variables. RESULTS Tobacco chewing was found to be a major risk factor for developing H & N cancer in 90% of subjects. Incidence of difficult laryngoscopy was 46.66% and incidence of difficult intubation was 20% in our study. On doing univariate logistic regression analysis, Cormack Lehane grade >=3 was found to have significant correlation with difficult intubation but on assessing independent correlation using multivariate regression analysis, none of the predictors had any significant correlation with difficult intubation. CONCLUSIONS The routine bedside predictors of difficult airway are not accurate indicators of difficult intubation in Head & Neck cancer surgical patients.