Retrospective Analysis of Factors Associated With Increased Anesthesia Ready Time in Patients With Odontogenic Infections.

BACKGROUND

Airway management in patients with odontogenic infections presents a known challenge. The current study aims to identify factors associated with anesthesia ready time (ART) and first-attempt intubation failure (FAIF) in patients with odontogenic infections.

METHODS

In a retrospective cohort study, subjects 14 years and older between January 1, 2012, and December 31, 2019, requiring incision and drainage for odontogenic infections under general anesthesia were included. Predictor variables included age, sex, race, body mass index (BMI), maximum incisal opening (MIO), Mallampati score, size and location of abscesses, airway deviation, intubation method, and route. The primary outcome variable, ART, was measured as the time elapsed between the patient entering the operating room and the anesthesiologist marking "Anesthesia Ready." A secondary outcome variable was FAIF. T tests, analysis of variance (ANOVA), or nonparametric tests were used to compare ART values based on our predictor variables. Logistic regression was used to assess for FAIF. A significance level of P ≤ .05 was used.

RESULTS

The sample was composed of 137 intubations in 129 subjects with a mean age of 38.6 (standard deviation [SD] 7.1) years, of which 59 (45.7%) were male. Mean ART was 19.2 (SD 10.4) [95% confidence interval [CI], 17.5-20.9] minutes. Abscess size was not associated with ART. Factors associated with increased ART were severe airway deviation (mean 23.0 [95% CI, 19.4-26.6] minutes, P = .02), involvement of the sublingual (mean 20.5 [95% CI, 18.1-22.8] minutes, P = .02), lateral pharyngeal (mean 21.7 [18.5-24.9] minutes, P = .02), and retropharyngeal (mean 24.7 [18.1-31.3] minutes, P = .02) spaces, total number of spaces involved (r = 0.18, P = .03), choice of flexible scope (FS) intubation (mean 26.8 [95% CI, 22.6-31.0] minutes, P < .01), and nasal route of intubation (mean 24.2 [95% CI, 21.3-27.2 minutes, P < .01)], the last 2 of which maintained significance after Bonferroni correction for multiple comparisons. FS intubation method remained significantly associated with increased ART, regardless of whether oral or nasal route was used ( P < .01). FAIF was encountered 13.3% of the time.

CONCLUSIONS

For patients with odontogenic infections, the strongest predictor of increased ART is the choice of FS technique. Other factors that may be associated with increased ART are severe airway deviation, number of spaces involved, involvement of the sublingual, lateral pharyngeal, or retropharyngeal spaces, although these other factors lose statistical significance after correction for multiple comparisons.