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Abstract
Background: Securing a definitive airway in patients undergoing coronary artery bypass graft (CABG) surgery is a high-stakes clinical intervention. In this vulnerable cohort, prolonged or failed intubation attempts can precipitate catastrophic hemodynamic instability, exacerbating myocardial oxygen supply-demand mismatch. Despite these inherent risks, the precise epidemiological burden of difficult airway management in this targeted cardiac surgical population is insufficiently documented.
Objective: To determine the precise prevalence of difficult laryngoscopy and difficult tracheal intubation among adult patients undergoing elective CABG surgery under general anesthesia, and to evaluate standard anthropometric predictors within this cohort.
Methods: Following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, this prospective, descriptive cross-sectional study was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi. A cohort of 121 consecutive adult patients scheduled for elective CABG, fulfilling strict inclusion criteria, was enrolled. Difficult laryngoscopy was preoperatively defined as a Modified Mallampati Classification (MMC) of Class III or IV. Difficult intubation was defined as requiring more than three attempts for successful endotracheal placement using conventional direct laryngoscopy. Descriptive and stratified statistical analyses were performed to identify correlations with advanced age and obesity.
Results: The cohort consisted of 70 males (57.9%) and 51 females (42.1%), with a mean age of 58.76 ± 15.57 years and an elevated mean body mass index (BMI) of 31.21 ± 2.14 kg/m². The incidence of difficult laryngoscopy was 35.5% (n = 43), while difficult tracheal intubation was documented in 36.4% (n = 44) of the study population. Stratified analyses indicated that traditional predictors, such as BMI > 30 kg/m² and age > 60 years, did not reach statistical significance as independent predictors of a difficult airway in this surgical population.
Conclusion: There is a remarkably high prevalence of both difficult laryngoscopy and intubation in patients presenting for CABG surgery, exceeding historical averages reported in general surgical populations. Routine preoperative airway metrics may be inadequate predictors in advanced cardiovascular disease. Anesthesiologists must maintain heightened vigilance and ensure immediate availability of advanced airway adjuncts to mitigate adverse perioperative cardiac events