Abstract
BACKGROUND AND AIMS: Cardiac surgery patients often present challenging airways and limited cardiopulmonary reserves, necessitating meticulous preoperative assessment by the anesthesia team. This observational study aimed to determine the incidence of difficult airways in cardiac surgery patients and identify predictive factors. By addressing a gap in regional data, the study seeks to inform clinical protocols, enhance training programs, and improve patient outcomes. METHODS: A cross-sectional study was conducted in the preoperative unit and cardiac operating rooms, involving American Society of Anaesthesiologists (ASA) I-IV patients aged 30-70 years who were electively scheduled for cardiac surgeries. Univariable and multivariable regression models were performed to determine the associated factors with difficult mask ventilation (DMV) and difficult intubation (DI). RESULTS: A total of 143 patients were included, of whom 113 (79%) were male. Difficult mask ventilation (DMV) occurred in 18 patients (12.6%), while difficult intubation (DI) occurred in 9 patients (6.3%). Among DMV cases, 17 (94%) were Grade III and 1 (0.7%) was Grade IV. Edentulous status (OR 9.92), snoring history (OR 9.90), BMI ≥ 35 kg/m² (OR 9.07), and high STOP-BANG score (OR 11.53) were significant univariable predictors of DMV. For DI, edentulous (OR 10.73), snoring (OR 18.15), upper lip bite test class II/III (OR 5.14), neck circumference > 16 inches (OR 4.71), and high STOP-BANG (OR 36.75) were significant. In multivariable analysis, edentulous status (AOR 377.1) and BMI ≥ 35 kg/m² (AOR 184.8) remained independent predictors of DMV, while edentulous status (AOR 36.75) and snoring history (AOR 8.56) remained independent predictors of DI. Patients with three or more risk factors had a markedly higher likelihood of DMV (OR 5.58). CONCLUSION: Our findings reveal a moderate incidence of DMV and DI in cardiac surgery patients. Edentulous status, snoring history, and a high STOP-BANG score are key predictors for both conditions. BMI ≥ 35 kg/m² and age ≥ 50 were specifically significant for DMV, while the upper lip bite test and neck circumference > 16 inches were associated with DI. Patients with three or more risk factors were notably prone to DMV. Identifying patients with three or more risk factors is crucial for optimizing airway management in cardiac surgery, highlighting the need for further validation and guideline integration.