Authors: Govind A, et al.
Anesthesia & Analgesia. September 05, 2025. doi: 10.1213/ANE.0000000000007740
This retrospective cohort study reviewed 137 intubations for incision and drainage of odontogenic infections under general anesthesia between 2012 and 2019. Researchers examined factors affecting anesthesia ready time (ART) and first-attempt intubation failure (FAIF).
The mean ART was 19.2 minutes. The strongest predictor of prolonged ART was use of a flexible scope (26.8 minutes on average), regardless of whether an oral or nasal route was chosen. Nasal intubation itself also prolonged ART (24.2 minutes), as did severe airway deviation and infections involving multiple deep spaces (sublingual, lateral pharyngeal, retropharyngeal). Abscess size was not a significant factor. First-attempt intubation failure occurred in 13.3% of cases.
What You Should Know
• Flexible scope intubation significantly prolongs anesthesia ready time.
• Nasal intubation also increases ART compared with oral intubation.
• Severe airway deviation and multiple-space infections contribute to longer ART but lose significance after correction.
• First-attempt intubation failure occurs in about 1 in 8 cases.
• Abscess size does not predict anesthesia ready time.
Practice Implication
For patients with odontogenic infections, anesthesia teams should anticipate longer anesthesia ready times when flexible scope or nasal intubation is planned. Careful preparation and communication with surgical teams can help mitigate delays, and strategies to optimize first-attempt intubation success should be emphasized.
References
Govind A, et al. Anesth Analg. 2025. doi:10.1213/ANE.0000000000007740
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