Prediction and Prevalence of Difficult Intubation in Major Ethnic Groups of Nepal

Abstract

Introduction: Preoperative identification of patients at risk for difficult laryngoscopy is important in adopting safer alternative strategies for the induction of anesthesia and intubation. There are many ethnic groups in Nepal but this study is to see the prevalence of difficult intubation in major ethnic groups of Nepal broadly classified as Mongolians, Aryans, Newars and Madhesi. There are various bedside tests to predict the difficult intubation, like Mallampati test, Thyromental distance, Sternomental distance and mouth opening. Difficult laryngoscopy as graded by Cormack and Lehane has been considered a surrogate indicator of difficult intubation. To see the prevalence of difficult intubation in major ethnic groups of Nepal and to compare the different bedside tests for prediction of difficult intubation in that population at Kathmandu Model Hospital from July to September 2023.

Methods: This retrospective study was conducted at the Department of Anesthesiology in Kathmandu Model Hospital, Nepal from July to September on patients who underwent elective surgery under general anesthesia with endotracheal intubation. Data on socio-demographic characteristics, preanesthetic airway assessment and laryngoscopic view were collected. Data were analyzed by SPSS.

Results: Difficult intubation was seen in 5.3% with 0.88% in Chettris, 0.88% in Madhesi and 3.5% in Newars. Malampati grading showed sensitivity of 33.3% and mouth opening showed sensitivity of 33.3%. However, highest specificity of the tests was found to be in Malampati grading with 98.1%.

Conclusion: Prevalence of difficult laryngoscopy in different ethnic groups of Nepalese population was found to be similar to that of other population. The predictors for difficult intubation were sensitive for Mallampati grading and mouth opening (MMP), as well as specific to MMP.