Utilization of apnea-hypopnea index as a novel predictive factor for difficult mask ventilation in the Chinese population under general anesthesia

Jiayi Wang,Xuan Pu,Pengcheng Zhao,Hong Jiang,Jingjie Li,Rong Hu

doi:10.1007/s11325-021-02310-6

Abstract

PurposeDifficult mask ventilation (DMV) is a potentially life-threatening situation that can arise during anesthesia. However, most clinical predictors of DMV are based on European and US populations. On the other hand, most predictive models consist of multiple factors and complicated assessments. Since obstructive sleep apnea (OSA) is among the most important risk factors associated with DMV, the apnea-hypopnea index (AHI) may play an important role in determining patient risk.The purpose of this study was to investigate the relationship between DMV and AHI, and to determine preoperative risk factors for DMV in Chinese patients.MethodsA prospective cohort trial enrolled patients scheduled for elective surgery. After obtaining informed consent, patient demographic information was collected, and patients were tested with pre-operative polysomnography. The anesthesiologist who managed the airway graded the mask ventilation. The difficult mask ventilation was defined as the mask ventilation provided by an unassisted anesthesiologist without oral airway or other adjuvant. A logistic regression model was used to analyze the association between AHI and DMV.ResultsA total of 159 patients were analyzed. For both primary and secondary outcomes, the unadjusted and adjusted odds ratio for DMV showed significant increases by 5 AHI units. AHI, age, and the Mallampati classification were found to be independent predictive factors for DMV.ConclusionsAHI is associated with DMV as a novel independent risk factor in Chinese patients. Along with age and Mallampati classification, AHI should be included in establishing a superior predictive strategy for DMV screening.Trial registrationChinese Clinical Trial Registry ChiCTR-DDD-17013076

Highlights

One essential aspect of airway management in general anesthesia is to evaluate the effectiveness of mask ventilation forJiayi Wang and Jingjie Li contributed to this work.patients [1]
Since obstructive sleep apnea (OSA) is among the most important risk factors associated with Difficult mask ventilation (DMV), the apnea-hypopnea index (AHI) may play an important role in determining patient risk.The purpose of this study was to investigate the relationship between DMV and AHI, and to determine preoperative risk factors for DMV in Chinese patients
The difficult mask ventilation was defined as the mask ventilation provided by an unassisted anesthesiologist without oral airway or other adjuvant

Summary

Introduction

One essential aspect of airway management in general anesthesia is to evaluate the effectiveness of mask ventilation forJiayi Wang and Jingjie Li contributed to this work.patients [1]. One essential aspect of airway management in general anesthesia is to evaluate the effectiveness of mask ventilation for. The incidence of difficult mask ventilation (DMV) is between 0.08 and 15% [2,3,4,5]. Difficult ventilation is considered the major contributing factor for morbidity and mortality related to anesthesia [1, 6]. It is important to evaluate the airway and predict the problems prior to induction; the 4th National Audit Project (NAP4) and other major anesthesia societies recommend a pre-operative assessment for every patient’s airway [1, 7,8,9]. A series of studies on the prediction and treatment of DMV (difficult mask ventilation) have been conducted. An age >55, body mass index (BMI)>26 kg/m2, presence of beard, no teeth, and snoring are

Objectives

Methods

Conclusion