Effect of Anesthesia Type on Airway Assessment Tests in Cesarean Delivery Operations: A Prospective Comparative Study

Abstract

Background: Pregnancy-related anatomical and physiological changes, such as mucosal edema and increased oxygen demand, heighten risk of difficult airway, especially under general anesthesia. This study compared effects of spinal and general anesthesia on postoperative airway assessment tests in cesarean deliveries. We hypothesized upper airway changes can occur depending on anesthesia technique. Material/Methods: This prospective observational study included 100 pregnant women undergoing elective cesarean delivery. Patients were divided into 2 groups according to anesthesia type: spinal (n=64) and general (n=36). Five basic airway assessment tests (modified Mallampati score, thyromental distance, sternomental distance, neck circumference, and upper lip bite test) were performed preoperatively and 1, 6, and 24 h after surgery (T1-T4). Results: No significant changes were observed over time in the spinal group (all P>0.05), with Mallampati scores remaining stable from T1 to T4 (mean T1: 1.7±0.6; T4: 1.8±0.5). In contrast, general anesthesia group showed a significant increase in Mallampati scores at T2 (T1: 1.7±0.6 vs T2: 2.4±0.7, P<0.001). Postoperative nausea and vomiting were more frequent in the general anesthesia group (27.8% vs 10.9%, P=0.016). In hemodynamic evaluation, systolic and diastolic blood pressure values were significantly higher at the 2nd and 5th minutes in the general anesthesia group (2nd min SBP: 128.4±20.6 mmHg vs 114.5±17.4 mmHg; 5th min SBP: 121.4±15.6 mmHg vs 107.1±14.7 mmHg; both P<0.001). Conclusions: The significant increase in Mallampati scores after general anesthesia highlights the potential for upper airway edema due to intubation. Anticipating this risk is important for airway safety in the early postpartum period.