Preoperative STOP-BANG Questionnaire to Predict Difficult Airway in Undiagnosed Obstructive Sleep Apnea Patients Undergoing Elective Gynecological Surgeries under General Endotracheal Anesthesia: A Prospective Observational Study

Feb 15, 2024Annals of African medicine

Using the STOP-BANG questionnaire before surgery to predict breathing problems during anesthesia in undiagnosed sleep apnea patients having planned gynecological operations

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Abstract

In a study of 250 patients, 59.8% of those with a STOP-BANG score of 3 or higher experienced difficult mask ventilation during anesthesia induction.

Difficult mask ventilation occurred in 26.8% of all patients, with a significantly higher rate in those with a STOP-BANG score ≥3.
The incidence of difficult tracheal intubation was 25.2%, with a marked increase to 56.9% in patients scoring ≥3 on the STOP-BANG questionnaire.
Airway complications such as bleeding and injury to the posterior pharyngeal wall or teeth were more frequent in patients with higher STOP-BANG scores.
Higher rates of hypoxia, hypertension, and tachycardia were associated with patients in the higher STOP-BANG score group.

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BACKGROUND: STOP-BANG questionnaire is an established tool for obstructive sleep apnea (OSA) screening. Its utility in predicting difficult airway has not been evaluated. We intend to assess difficulty in airway management and associated perioperative complications in patients with undiagnosed OSA using the STOP-BANG questionnaire.

MATERIALS AND METHODS: We performed a prospective observational study on 250 patients with the American Society of Anesthesiologists Physical Status Class I-II, aged 18-65 years STOP-BANG score were recorded. Occurrences of difficult mask ventilation (DMV), laryngoscopy, and intubation were assessed using mask ventilation grade, intubation difficulty score intubation difficult score (IDS), and modified Cormack-Lehane grading during induction of anesthesia. Hypoxic events, hemodynamic disturbances, laryngospasm, and bronchospasm were also recorded.

RESULTS: Overall, 250 patients completed the study (Group H: n = 102, with STOP-BANG questionnaire ≥3 and Group L: n = 148, with STOP-BANG criteria < 3). A total of 67 (26.8%) cases of DMV and 63 (25.2%) cases of difficult tracheal intubation (DIT) were encountered overall. The proportion of patients with DMV during induction was 59.8% in Group H versus 4.05% in Group L (P < 0.001). A higher incidence of difficult intubation was observed in Group H (56.9% vs. 11.5%, P < 0.001). More patients in Group H had airway complications such as bleeding and injury to the posterior pharyngeal wall or teeth (P < 0.001). Complications such as hypoxia, hypertension, and tachycardia were observed to be higher in Group H (P < 0.001).

CONCLUSION: STOP-BANG questionnaire is an effective bedside preoperative tool that helps in identifying unanticipated difficult airway.

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Preoperative STOP-BANG Questionnaire to Predict Difficult Airway in Undiagnosed Obstructive Sleep Apnea Patients Undergoing Elective Gynecological Surgeries under General Endotracheal Anesthesia: A Prospective Observational Study

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