• Woo-Young Jo, Sang Joon Park, Kyung Won Shin, Hee-Pyoung Park, and Hyongmin Oh.
• Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
• J Neurosurg Anesthesiol. 2025 Jan 3.

BackgroundPredictors of difficult fiberscopic intubation have not been fully elucidated. This study focused on identifying radiographic predictors of difficult fiberscopic intubation during general anesthesia in patients with a cervical collar.MethodsThis retrospective study included unconscious patients who underwent orotracheal intubation using a flexible fiberscope while wearing a cervical collar to simulate a difficult airway. Easy fiberscopic intubation was defined as successful fiberscopic intubation within 120 seconds on the first attempt without desaturation below 90%. The patients were divided into easy (n=133) and difficult (n=24) fiberscopic intubation groups. Demographic, mask ventilation-related, upper airway-related, and radiographic variables measured on sagittal images of preoperative cervical x-ray and magnetic resonance imaging were analyzed.ResultsThe difficult fiberscopic intubation group had a smaller oral cavity area (2.1 [1.2-2.5] vs. 2.9 [2.1-3.7] cm2, P<0.001), higher tongue area divided by oral cavity area (9.3 [6.5-13.3] vs. 6.4 [4.6-8.3], P<0.001), smaller epiglottis angle (33±10° vs. 37±8°, P=0.02), and longer skin-glottis distance (1.3 [1.1-1.6] vs. 1.1 [1.0-1.3] cm, P=0.004). Tongue area/oral cavity area (odds ratio per 1 [95% CI]: 1.24 [1.09-1.40]) and skin-glottis distance (odds ratio per 1 cm [95% CI]: 13.0 [2.69-62.4]) were independently associated with the difficulty in fiberscopic intubation.ConclusionsHigh tongue area/oral cavity area and long skin-glottis distance were predictive of difficult fiberscopic intubation during general anesthesia in patients with a cervical collar.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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