PloS one
Predictors of the need for airway adjuncts during mask ventilation in Thai adult patients undergoing general anesthesia: A prospective observational study
Por Karnjanawanichkul O, Nuanthong C, Pattaravit N y 3 más.
Contenido en inglés
Resumen
Background
Mask ventilation is a cornerstone of airway management during general anesthesia, yet the need for airway adjuncts during mask ventilation remains poorly predicted by current preoperative assessments. We aimed to identify independent clinical predictors of this outcome in Thai adults undergoing elective surgery.
Methods
This single-center prospective observational study included 266 adults undergoing elective general anesthesia at a university hospital in Thailand between September 2018 and October 2019. Preoperative airway assessment included Mallampati classification, dentition status, neck circumference, history of snoring or obstructive sleep apnea (OSA), and other standard variables. The primary outcome was the need for airway adjuncts or optimization during mask ventilation, defined as Han grade ≥2. Han grade ≥2 was selected because only 10 grade-3 events occurred, yielding an events-per-variable ratio of 2.5 under the grade ≥3 definition - insufficient for reliable multivariable regression. Independent predictors were identified using multivariable logistic regression with backward stepwise elimination. Discriminative ability was evaluated using receiver operating characteristic (ROC) analysis and area under the curve (AUC) for both neck circumference alone and the complete four-variable model. Bootstrap internal validation (1,000 resamples) was performed by repeating the model-building procedure, including univariable screening and backward stepwise elimination, within each resample.