Visibility of the glottis during the induction of general anesthesia in patients with obstructive sleep apnea syndrome: retrospective comparative study of video and direct laryngoscopy

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Background and purpose: Patients with obstructive sleep apnea syndrome (OSAS) may present as an anesthetic challenge during the induction of general anesthesia for possible difficult airway management. The aim of this study was to share our experiences with airway management in OSAS patients during general anesthesia using video laryngoscopy (VL) and direct laryngoscopy (DL), hypothesizing that VL provides superior glottic visibility compared to DL. Materials and methods: We conducted a retrospective comparative study including two groups of adult patients with polysomnographically diagnosed OSAS who underwent uvulopalatopharyngoplasty and/or septoplasty under general anesthesia at the Sveti Duh University Hospital in Zagreb, Croatia. The DL group consisted of patients from January 2009 to August 2013, while the VL group included patients from January 2020 to December 2024. A questionnaire was completed for each patient, recording general, preoperative, intraoperative, and postoperative data relevant for airway management. Results: In the VL group (n=91), the distribution of glottic visibility according to the Cormack-Lehane classification from 1 (best view) to 4 (worst view) was as follows: 62 (68.1%) (score 1), 23 (25.3%) (score 2), 6 (6.6%) (score 3), and 0 (0%) (score 4). In the DL group (n=91), glottic visibility according to the Cormack-Lehane classification from 1 to 4 was as follows: 14 (15.4%) (score 1), 51 (56%) (score 2), 25 (27.5%) (score 3), and 1 (1.1%) (score 4). (p <0.001). Conclusions: In our study, VL provided better glottic visibility in adult patients with obstructive sleep apnea compared to DL.

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