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Background An unexpected difficult intubation occurs because physical examination of the airway is imperfect in predicting it. Lingual tonsil hyperplasia (LTH) is one risk factor for an unanticipated failed intubation that is not detectable during a routine oropharyngeal examination. The authors attempted to determine the incidence of LTH in unanticipated failed intubation in patients subjected to general anesthesia. Methods Thirty-three patients with unanticipated failed intubation via direct laryngoscopy were subjected to airway examinations and fiberoptic pharyngoscopy to determine the cause(s) of failure. Mouth opening, mandibular subluxation, head extension, thyromental distance, and Mallampati airway class were recorded. Fiberoptic pharyngoscopy was then performed to evaluate the base of the tongue and valleculae. Results Of these 33 patients, none had an airway examination that suggested a difficult intubation. The lungs of 12 patients were difficult to ventilate by mask. In 15 patients, airway measurements were within normal limits with Mallampati class of I or II. Ten patients had a Mallampati class III airway, 6 associated with obesity and 5 with mildly limited head extension. Among the 5 morbidly obese patients, most of the weight was distributed on the lower trunk and body. The 3 remaining patients had a thyromental distance of 6 cm or less but otherwise had a normal airway examination. The only finding common to all 33 patients was LTH observed on fiberoptic pharyngoscopy. Conclusion Lingual tonsil hyperplasia can interfere with rigid laryngoscopic intubation and face mask ventilation. Routine physical examination of the airway will not identify its presence. The prevalence of LTH in adults and the extent of its contribution to failed intubation is unknown.

An unexpected difficult intubation occurs because physical examination of the airway is imperfect in predicting it. Lingual tonsil hyperplasia (LTH) is one risk factor for an unanticipated failed intubation that is not detectable during a routine oropharyngeal examination. The authors attempted to determine the incidence of LTH in unanticipated failed intubation in patients subjected to general anesthesia.Thirty-three patients with unanticipated failed intubation via direct laryngoscopy were subjected to airway examinations and fiberoptic pharyngoscopy to determine the cause(s) of failure. Mouth opening, mandibular subluxation, head extension, thyromental distance, and Mallampati airway class were recorded. Fiberoptic pharyngoscopy was then performed to evaluate the base of the tongue and valleculae.Of these 33 patients, none had an airway examination that suggested a difficult intubation. The lungs of 12 patients were difficult to ventilate by mask. In 15 patients, airway measurements were within normal limits with Mallampati class of I or II. Ten patients had a Mallampati class III airway, 6 associated with obesity and 5 with mildly limited head extension. Among the 5 morbidly obese patients, most of the weight was distributed on the lower trunk and body. The 3 remaining patients had a thyromental distance of 6 cm or less but otherwise had a normal airway examination. The only finding common to all 33 patients was LTH observed on fiberoptic pharyngoscopy.Lingual tonsil hyperplasia can interfere with rigid laryngoscopic intubation and face mask ventilation. Routine physical examination of the airway will not identify its presence. The prevalence of LTH in adults and the extent of its contribution to failed intubation is unknown.

The causes of death among anesthesiologists from 1930 through 1946 were determined and compared to the causes of death for contemporaneous physicians as well as anesthesiologists in later eras. Names of US white male anesthesiologists listed in the annual Directories of Anesthetists compiled by the International Anesthesia Research Society were searched for in the death files of the American Medical Association. Among those listed in the Directories 274 deaths were located. Causes were ascertained for 269 deaths and 259 causes were verified from death certificates. The leading causes of death of anesthesiologists and other physicians of the same era were cardiovascular-renal diseases and malignant neoplasms. The death rate from all causes was lower among anesthesiologists than among contemporaneous white men and other physicians. Death rates among anesthesiologists from 1930-1946 were similar to those among anesthesiologists in 1947-1956, but greater than those for 1957-1971. Among deaths from malignant neoplasms, those of the digestive organs were the most frequent and those of the respiratory tract the least. Anesthesiologists practicing in the earlier part of this century had lower death rates and they were less likely to die of malignant neoplasms than contemporaneous white men. The death rates for these anesthesiologists were similar to those for anesthesiologists during 1947-1956, but greater than rates observed for anesthesiologists during 1957-1971. This suggests that exposure to the fluorinated anesthetic agents introduced in the mid-1950s may not be an important health hazard. Language: en