Clinical Characteristics of Patients Presenting with Difficult Mask Ventilation in the Operating Room at Hu Pzaga Mahajanga (Madagascar)

Introduction: Face mask ventilation is a fundamental skill in general anaesthesia, used both for preoxygenation and as a rescue technique. Difficult mask ventilation represents a high-risk situation that may lead to severe hypoxemia. The aim was to assess the frequency of difficult mask ventilation and to describe the clinical characteristics of the affected patients.

Methods: This descriptive observational study was conducted over a 6-months period at University Hospital Professor Zafisaona Gabriel Mahajanga (Madagascar). A total of 167 patients undergoing surgery under general anaesthesia were included. Demographic and clinical data that could compromise mask ventilation were systematically collected.

Results: The frequency of difficult mask ventilation was 25.7%. Patients had a mean age of 34.8 ± 16.1 years, with a female majority (60%). Patients with difficult mask ventilation mainly presented with Mallampati class III (32.5%) or IV (39.5%), a thyromental distance < 6 cm (69.7%), a mean BMI of 23.56 ± 5.40 kg/m², and snoring (62.1%).

Discussion: The high frequency of difficult mask ventilation observed in this series highlights the persistence of this issue in general anaesthesia, and especially in resource-limited settings. The predictive clinical factors identified in our patients are consistent with those reported in the literature.

Conclusion: This study shows that difficult ventilation is a significant reality in our anaesthetic practice in Mahajanga. It emphasizes the crucial importance of systematic preoperative airway assessment to improve patient safety.