The causes of difficult tracheal intubation and preoperative assessments in different age groups

• Main Authors: Hyoung-Yong Moon, Chong Wha Baek, Jin-Seo Kim, Gill Hoi Koo, Jin-Yun Kim, Young-Cheol Woo, Yong Hun Jung, Hyun Kang, Hwa-Yong Shin, So-Young Yang
• Format: Article
• Language: English
• Published: Korean Society of Anesthesiologists 2013-04-01
• Series: Korean Journal of Anesthesiology
• Subjects: aging; difficult; endotracheal intubation; laryngoscopy
• Online Access: http://ekja.org/upload/pdf/kjae-64-308.pdf

BackgroundWe studied the differences in airway assessment factors among old, middle, and young age groups, and evaluated the frequency and causes of difficult intubation among these groups.MethodsPatients were divided into young (< 40 yr, n = 75 ), middle (40-59 yr, n = 83), and old (≥ 60 yr, n = 89) group. Airway assessment factors such as head and neck movement, thyromental distance, interincisor gap, dentition, Mallampati score, and Arné score were assessed. After muscle relaxation, cervical joint rigidity and Cormack-Lehane (C-L) grade were assessed. The differences in airway assessment factors between difficult (C-L grade 3, 4) and easy (C-L grade 1, 2) intubation were then examined. Logistic regression analysis was also carried out to identify the extent to which airway assessment factors reflected difficult intubation.ResultsAs aging, head and neck movement, thyromental distance, and interincisor gap decreased, the grade of dentition, Mallampati score, cervical joint rigidity and the ratio of Arné score > 11 increased. In the old and middle group, the incidence of difficult intubation was increased compared with the young group. Dentition in the young group, Mallampati score and interinsisor gap in the middle group and Mallampati score, cervical joint rigidity in the old group respectively predicted difficult intubation.ConclusionsCompared to young individuals, middle-aged or elderly adults are likely to experience more difficulty in endotracheal intubation and its predictive factors could vary by age group.