METHODS: Forty-four patients with oropharyngeal masses scheduled for surgery were observed during the process of airway management. Observers recorded the number of airway devices used, the overall number of intubation attempts, the number and type of manual maneuvers required during bag mask ventilation, and the incidence of oxygen desaturation. The eventual intubation success rate was also recorded.
RESULTS: All 44 patients (100%; 95% CI, 92%–100%) were successfully intubated. Thirty-six (81.8%) of 44 patients were intubated asleep and 8 (18.2%) of 44 were intubated awake using flexible fiberoptic bronchoscopy. Thirty-one (86.1%) of 36 patients who were intubated asleep received bag mask ventilation before intubation, while the other 5 patients underwent a rapid sequence induction. Twenty-seven (61.4%) of 44 patients (95% CI, 45%–75%) had ≥1 complication during airway management. Ten (23%) of 44 patients (95% CI, 11%–37%) required ≥3 attempts to intubate, 21 (68%) of 31 patients (95% CI, 49%–83%) had difficult mask ventilation, and 15 patients (34%; 95% CI, 20%–50%) experienced desaturation (oxygen saturation measured by pulse oximetry, <95%).
CONCLUSIONS: We found that, although all patients were successfully intubated, clinicians frequently encountered complications with both intubation and mask ventilation. These complications required frequent use of additional manual maneuvers during mask ventilation and a high incidence of oxygen desaturation. The difficulty of airway management in patients with oropharyngeal masses may not be effectively assessed by success rate alone.