• Zuhair A Siddiqui, Arvind Chandrakantan, Emma E Hills, Christopher N Nguyen, Benjamin M Todd, and Adam C Adler.
• Department of Anesthesiology, Perioperative and Pain Medicine; Texas Children's Hospital, Houston, TX; Baylor College of Medicine, Houston, TX.
• J. Cardiothorac. Vasc. Anesth. 2021 Dec 1; 35 (12): 3659-3664.

ObjectiveTo identify the incidence of difficult intubation in patients with adult congenital heart disease (ACHD) undergoing cardiac surgery or catheterization.DesignA retrospective cohort study.SettingA single-center academic quaternary pediatric hospital.ParticipantsAll patients were >18 years of age with ACHD undergoing endotracheal intubation within the Heart Center at Texas Children's Hospital between January 2012 and December 2019.InterventionsNone.Measurement And Main ResultsA retrospective chart review was performed, including patient demographics, preoperative airway assessment and intraoperative airway management characteristics. Airways were categorized as difficult using the Pediatric Difficult Intubation registry operational definitions. For patients classified as having a difficult airway, the preoperative airway examination findings were recorded in addition to factors associated with difficult airway in the adult. The study authors identified 1,029 patients with ACHD who underwent procedures with anesthesia at their institution and were analyzed for the presence of difficult airway. In total, 878 patients were intubated, with 4.3% (n = 38) identified to have difficult airway. The presence of concomitant syndromes was greater in patients with difficult intubations and those who were not intubated compared with those who were not difficult intubations (23.7% and 17.2 v 7.5; p < 0.001), respectively. Most patients did not have typical signs associated with difficult intubation.ConclusionsThe study authors identified an incidence of difficult laryngoscopy in their cohort of ACHD patients to be 4.3%. Their incidences of difficult laryngoscopy were fewer than that reported in adult patients with noncongenital heart disease. Most importantly, the risk factors associated with difficult laryngoscopy in the normal adult may be different from those presenting with ACHD, necessitating further investigation.Copyright © 2021 Elsevier Inc. All rights reserved.

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