Magnitude and associated factors of difficult airway in adult patients undergoing elective maxillofacial surgery with endotracheal intubation at selected public hospitals, Addis Ababa, Ethiopia, 2021: A cross-sectional study

Difficult airway management during maxillofacial surgery is a critical concern for anesthetists, with significant implications for patient morbidity and mortality. This study aimed to assess the magnitude and associated factors of difficult airway in adult patients undergoing elective maxillofacial surgery with endotracheal intubation at selected public hospitals in Addis Ababa, Ethiopia. An institution-based cross-sectional study was conducted from January 22, 2021, to May 2021, involving 208 adult patients who underwent elective maxillofacial surgery. Data were collected using a structured questionnaire and analyzed using SPSS version 24. Binary and multivariate logistic regression analyses were performed to identify factors associated with difficult airway management. The overall magnitude of difficult airway was found to be 23.1%. The magnitude of difficult laryngoscopy, difficult intubation, difficult mask ventilation, and failed intubation were 17.8%, 16.3%, 5.3%, and 0.96%, respectively. Factors significantly associated with difficult airway included upper lip bite test class III (AOR = 7.636), oropharyngeal view class IV (AOR = 4.902), sternomental distance <12 cm (AOR = 6.167), thyromental distance <6 cm (AOR = 4.581), BMI >30 kg/m 2 (AOR = 2.592), age >55 years (AOR = 4.844), and history of snoring (AOR = 3.574). The study revealed a high prevalence of difficult airway among patients undergoing maxillofacial surgery. Emphasis should be placed on preoperative assessment and preparation, including the availability of advanced airway management tools and training in alternative techniques. • The overall magnitude of difficult airway among maxillofacial surgical patients was found to be 23.1%. • Inability to use both alternative techniques and laryngeal applied pressure increase the incidence of difficult airway. • BMI >30 kg/m 2 , Age >55 years, and History of snoring were significantly associated with difficult airway with, p values less than 0.05