Chapter 36 Airway assessment and management

The key to success in patients with difficult airway is effective airway assessment and meticulous planning. Making use of simple and time-tested equipment and modifying these methods accordingly enable successful airway control avoiding perioperative morbidity and mortality . We report a case of 75 year old male with posterior urethral stricture planned for perineal urethroplasty with anticipated difficult airway. The airway was managed using video laryngoscopy and the procedure was uneventful with good postoperative recovery. This case report insists on making use of other conventional methods in the effective management of an anticipated difficult airway during a pandemic.

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Difficult Airway Prediction Score for Intubation in Emergency Departments: A Retrospective Cohort Study

10.21203/rs.3.rs-1087598/v1 ◽

2021 ◽

Author(s):

Sorravit Savatmongkorngul ◽

Panrikan Pitakwong ◽

Pungkava Srichar ◽

Chaiyaporn Yuksen ◽

Chetsadakon Jenpanitpong ◽

...

Keyword(s):

Emergency Department ◽

Difficult Airway ◽

Endotracheal Intubation ◽

Difficult Intubation ◽

Prediction Score ◽

Care Hospital ◽

Inclusion Criteria ◽

Assessment Score ◽

Airway Assessment ◽

Lehane Grade

Abstract Objective: Difficult intubation is associated with an increasing number of endotracheal intubation attempts. Repeated endotracheal intubation attempts are in turn associated with an increased risk of adverse events. Clinical prediction tools to predict difficult airway have limited application in emergency airway situations. This study was performed to develop a new model for predicting difficult intubation in the emergency department.Methods: This retrospective study was conducted using an exploratory model at the Emergency Medicine of Ramathibodi Hospital, a university-affiliated super-tertiary care hospital in Bangkok, Thailand. The study was conducted from June 2018 to July 2020. The inclusion criteria were an age of ≥15 years and treatment by emergency intubation in the emergency department. Difficult intubation was defined as a Cormack–Lehane grade III or IV laryngoscopic view. The predictive model and prediction score for detecting difficult intubation were developed by multivariable regression analysis.Results: During the study period, 617 patients met the inclusion criteria; of these, 83 (13.45%) had difficult intubation. Five independent factors were predictive of difficult intubation. The difficult airway assessment score that we developed to predict difficult airway intubation had an accuracy of 89%. A score of >4 increased the likelihood ratio of difficult intubation by 7.62 times.Conclusion: A difficult airway assessment score of >4 was associated with difficult intubation.

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Hyo-Mental Angle and Distance: An Important Adjunct in Airway Assessment of Adult Mucopolysaccharidosis

Journal of Clinical Medicine ◽

10.3390/jcm10214924 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4924

Author(s):

Chaitanya Gadepalli ◽

Karolina M. Stepien ◽

Govind Tol

Keyword(s):

Lysosomal Storage Disorder ◽

Hyoid Bone ◽

Horizontal Axis ◽

Moderate Correlation ◽

Lysosomal Storage ◽

Airway Assessment ◽

Storage Disorder ◽

Age Range ◽

Mps I ◽

Simpler Method

Background: Mucopolysaccharidosis (MPS) is a rare congenital lysosomal storage disorder with complex airways. High anterior larynx is assessed by thyromental distance (TMD) nasendoscopy. A simpler method to assess this hyoid bone is described. The distance between the central-hyoid and symphysis of the mandible (hyo-mental distance; HMD) and inclination of this line to the horizontal axis (hyo-mental angle; HMA) in neutrally positioned patients is investigated. Methods: HMA, HMD in MPS, and non-MPS were compared, and their correlation with height and weight were assessed. Results: 50 adult MPS patients (M = 32, F = 18, age range = 19–66 years; mean BMI = 26.8 kg/m2) of MPS I, II, III, IV, and VI were compared with 50 non-MPS (M = 25, F = 25; age range = 22–84 years; mean BMI = 26.5 kg/m2). Mean HMA in MPS was 25.72° (−10 to +50) versus 2.42° (−35 to +28) in non-MPS. Mean HMD was 46.5 (25.7–66) millimeters in MPS versus 41.8 (27–60.3) in non-MPS. HMA versus height and weight showed a moderate correlation (r = −0.4, p < 0.05) in MPS and no significant correlation (r < 0.4, p > 0.05) in non-MPS. HMD versus height and weight showed no correlation (r < 0.4, p > 0.05) in both groups. Conclusions: HMA seems more acute in MPS despite nearly the same HMD as non-MPS, signifying a high larynx, which may be missed by TMD.

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