Investigation of Factors Predicting Difficult Airway Management in Emergency Surgical Patients at Gombe State University Teaching Hospital

Unanticipated difficult airway management during emergency anaesthesia represents a major cause of anaesthesia-related mortality and hypoxic brain injury in Nigerian theatres, particularly where pre-anaesthetic assessment time is limited. This study investigates the clinical predictors of difficult airway management in emergency surgical patients at Gombe State University Teaching Hospital, Gombe State, North East Nigeria. A prospective cohort design is applied over a 12-month period, enrolling all consecutive adult emergency surgical cases receiving general anaesthesia. Pre-induction airway assessment is performed using the modified Mallampati score, thyromental distance, neck circumference, mouth opening, and upper lip bite test. Difficult airway is defined as any case requiring more than two laryngoscopy attempts, use of a rescue device, or surgical airway. Multivariable logistic regression in SPSS identifies the strongest predictor combination. Available airway management literature from North East Nigeria identifies modified Mallampati class III or IV and reduced thyromental distance as the most predictive individual parameters, with a composite scoring tool outperforming any single predictor. The ASA Difficult Airway Algorithm and the Difficult Airway Society guidelines provide the management reference. Findings will support the anaesthesia department in implementing systematic pre-induction airway risk scoring and a structured difficult airway trolley policy. Keywords: difficult airway, emergency anaesthesia, airway management predictors, Gombe State, North East Nigeria.