Prevalence of difficult endotracheal intubation in unanticipated difficult airway in tertiary care centre of Arunachal Pradesh
Noyomi Saring, Tomar Basar
Background: Airway management is the cornerstone of practice of Anaesthesiology. For successful airway management requires a range of knowledge with experience in management of airway. Thereby Anaesthesiologist must identify and perform difficult airway management with competent skill when necessary. 10% of apparently normal airway patients may be difficult to intubate9. The DAS mention that serious complication can occur in 1:22000 and death of 1:150000 GA cases.7 Smita Prakash Et al5 found an incidence of 9.7% and 4.5% for difficult laryngoscopy and difficult intubation, respectively, in Indian population with apparently normal airways. Keeping in mind the ethnicity and racial population of Arunachal Pradesh (AP), this study was designed to evaluate the prevalence of difficult airway in Tertiary care centre of Arunachal Pradesh; Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, AP. Aims and Objectives: To assess the prevalence of difficult airway in the tertiary care centre of Arunachal Pradesh during Endo-Tracheal Intubation (ETT). Materials and Methods: The study was conducted in department of Anaesthesiology, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh. After obtaining clearance from medical ethics committee, all the adult patients age 18 to 70 of ASA status I or II with normal airway indices, who underwent routine surgery under general anaesthesia were included in the study. Standard local protocol was followed for general anaesthesia. The patients’ were intubated in supine and sniffing position to enable direct laryngoscopy, done with No 3 blade Macintosh laryngoscope al first attempts. The Modified Cormack-Lehane score were assessed with DL along with need of external laryngeal manipulation like BURP. The numbers of additional or multiple attempts for endotracheal intubation, time required to intubation, other modalities used to assist intubation, used of different blade size or ETT size and failed intubation is noted down. Failure to achieve successful tracheal intubation in a maximum of three attempts, fourth attempt should be done by more experience Anaesthesiologist. BJA (2015) 115 (6): 827–848). Results and Observation:The prevalence of Difficult Direct Laryngoscopy (DDL) and Difficult Intubation (DI) was 4.75% (19) and 1.25% (5) respectively. The difficult mask ventilation was seen in 3% of the patient. Of all the parameters used to measure pre-anaesthetic predictor of difficult intubation, only mCLS was most accurate, followed by ULBT and then, SMD, TMD, BMI and MMT. Conclusion: Prevalence of difficult intubation of population as per the Tertiary care centre of Arunachal Pradesh is 1.25% and prevalence of difficult direct laryngoscopy is 4.75%, difficult face mask ventilation of 0.75% and difficult airway in 5.5% in absolutely normal airway parameters.
Noyomi Saring, Tomar Basar. Prevalence of difficult endotracheal intubation in unanticipated difficult airway in tertiary care centre of Arunachal Pradesh. International Journal of Medicine Research, Volume 5, Issue 3, 2020, Pages 72-77