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Incidences and predictors of difficult laryngoscopy in adult patients undergoing general anesthesia

A single-center analysis of 102,305 cases



Hypoxemia caused by difficulties in airway management presents a major cause for perioperative morbidity and mortality. The ability to predict difficult laryngoscopy more accurately would enable anesthesiologists to take specific precautions to reduce airway risks and prevent patient-threatening events.


Over a 6-year period of time, all anesthesia records with a documented direct laryngoscopic view were retrieved from the electronic data management system and statistically processed. The Cormack–Lehane four-point scale of grading laryngoscopy was used to assess visibility of the vocal cords.


Of 102,306 cases, the overall rate of difficult laryngoscopy was 4.9 %. Male gender (6.5 %), Mallampati score III and IV (17.3 %), obesity with a BMI ≥35 kg/m2 (6.1 %), as well as physical status ASA III or IV (6.2 %), were identified as risk factors for difficult laryngoscopy. Patients undergoing surgery in the departments of oromaxillofacial (8.9 %), ear nose throat surgery (ENT) (7.4 %), and cardiac surgery (7.0 %) showed the highest rates of difficult laryngoscopy.


The results indicate that the risk for difficult airway situations might substantially differ between surgical patient groups. In hospitals with departmental structures and spatially separated operating rooms, the deduction might be increased awareness and particular structural preparation for difficult airway situations in the respective subspecialties.

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Correspondence to S. Heinrich.

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Heinrich, S., Birkholz, T., Irouschek, A. et al. Incidences and predictors of difficult laryngoscopy in adult patients undergoing general anesthesia. J Anesth 27, 815–821 (2013).

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  • Difficult airway
  • Poor laryngoscopic view
  • Airway management