scholarly journals Changes in the upper airway following induction of anaesthesia: a prospective observational study protocol to determine the use of ultrasound in the assessment of a difficult airway in China

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029782
Author(s):  
Fang Dong ◽  
Yong Wang ◽  
Xia Wang ◽  
Huanyi Zhao ◽  
Wuhua Ma
Keyword(s):  
Difficult Airway ◽  
General Anaesthesia ◽  
Upper Airway ◽  
Screening Tests ◽  
Rank Test ◽  
Correct Prediction ◽  
Tertiary Teaching ◽  
Lehane Grade ◽  
Before And After ◽  
Difficult Airways

IntroductionDifficult airway management is closely related to the safety and quality of medical care. However, the low incidence of correct prediction of difficult airway in clinical screening tests presents physicians with a dilemma. Depressed airway neuromuscular tension during sleep and anaesthesia tends to cause collapse of fragile parts of the upper airway. Although previous studies have confirmed that anterior cervical tissue thickness is associated with difficult airways, there is no evidence to support a correlation between a difficult airway and specific patterns or findings of anaesthesia-induced airway collapse. Thus, this study aims to examine changes in airway dimensions before and after induction of general anaesthesia to explore whether it could provide useful information regarding the specific anatomic changes occurring which may cause difficult airways.Methods and analysisThis will be a single-centre prospective observational single-blinded study, conducted in a tertiary teaching hospital in Guangzhou, China. Subjects will be recruited from patients (aged 18–65 years) scheduled for elective surgery under general anaesthesia. Sonographic measurement will be performed to detect changes in the thickness of the anterior cervical soft tissue before and after anaesthetic induction. Based on the resulting data distribution, analyses will initially compare these changes using a paired t-test or the Wilcoxon signed-rank test. The correlation of sonographic changes and Cormack–Lehane grade will be evaluated by using receiver-operating characteristic curves to detect the sensitivity and specificity of a measurement for detecting difficulties. Linear stepwise regression analysis will be used to assess the correlation between airway changes and demographic variables as well as clinical tests.Ethics and disseminationEthical approval has been obtained from the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (ZYYECK (2018) 041). The results will be disseminated through conference presentations, professional journals and peer-reviewed publications.Trial registration numberChiCTR1900021123; Pre-results.

scholarly journals Prediction of Difficult Airway Among Patients Requiring Endotracheal Intubation in a Tertiary Care Hospital in Eastern Nepal

2017 ◽  
Vol 56 (207) ◽  
pp. 314-318 ◽  
Author(s):  
Sindhu Khatiwada ◽  
Balkrishna Bhattarai ◽  
Krishna Pokharel ◽  
Roshan Acharya
Keyword(s):  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Tertiary Care ◽  
Difficult Laryngoscopy ◽  
Screening Tests ◽  
Care Hospital ◽  
Laryngoscopic View ◽  
Predictive Values ◽  
Lehane Grade

Introduction: Unanticipated difficult intubation is an undesirable situation. Various bedside screening tests are routinely performed for predicting difficult airway. Although considered a surrogate indicator, difficult laryngoscopy is not the exact measure of intubation difficulty. We aimed to determine the best screening test for predicting difficult laryngoscopy and the association between difficult laryngoscopic view and difficult intubation. Methods: This prospective, observational study involved 314, ASA I/II adult patients requiring endotracheal intubation for various routine surgical procedures. Sternomental distance < 12 cm, thyromental distance < 6.5cm, inter-incisor distance < 3.5 cm, mandibular protrusion grade 3 and modified Mallampati class III/IV were the predictors of difficult laryngoscopy. Laryngoscopic view was defined as ‘difficult’ when the Cormack and Lehane grade was III/ IV. The sensitivity, specificity, positive and negative predictive values and accuracy of these predictors were compared to find out the best predictor. Requirement of >3 attempts for insertion of the tracheal tube was defined as ‘difficult intubation’. The association between difficult laryngoscopic view and difficult intubation was determined. Results: The sensitivity of the modified Mallampati class for predicting difficult laryngoscopy was highest (83%). Twelve (3.8%) patients had grade III laryngoscopic view and none had a grade of IV. Intubation was difficult in seven (2.2%) patients. Majority of patients (4 of 7) with difficult intubation had difficult laryngoscopic view (p<0.001). Conclusions: Modified Mallampati test was better for predicting difficult laryngoscopy compared to other bedside screeing tests. Difficult laryngoscopy could significantly predict difficult intubation in our patients.   Keywords: Airway evaluation; difficult intubation; difficult laryngoscopy; modified Mallampati class; Nepalese patients; sensitivity.

Upper lip bite test compared to modified Mallampati test in predicting difficult airway in obstetrics: A prospective observational study

2021 ◽  
pp. 175045892110452
Author(s):  
Farnaz Moslemi ◽  
Zahid Hussain Khan ◽  
Elham Alizadeh ◽  
Zhila Khamnian ◽  
Negar Eftekhar ◽  
...  
Keyword(s):  
Observational Study ◽  
Difficult Airway ◽  
Difficult Intubation ◽  
Prospective Observational Study ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Upper Lip ◽  
Lehane Grade ◽  
Difficult Airways ◽  
Obstetric Population

Difficult airway and intubation can have dangerous sequela for patients if not managed promptly. This issue is even more challenging among obstetric patients. Several studies have aimed to determine whether the test to predict a difficult airway or difficult intubation, is higher in accuracy. This study aims to compare the upper lip bite test with the modified Mallampati test in predicting difficult airway among obstetric patients. During this prospective observational study, 184 adult pregnant women, with ASA physical status of II, were enrolled. Difficult intubations of Cormack-Lehane grade III and IV were defined as difficult airways and difficult intubation in this study. Upper lip bite test, modified Mallampati test, thyromental distance and sternomental distance were noted for all patients. Modified Mallampati test, upper lip bite test and sternomental distance had highest specificity. Based on regression analysis, body mass index and Cormack-Lehane grade have a significant association. Modified Mallampati test was the most accurate test for predicting difficult airway. The best cut-off points of thyromental distance and sternomental distance in our study were 5cm and 15cm, respectively, by receiver operating characteristic curve analysis. Based on the results of the present study, it can be concluded that in the obstetric population, modified Mallampati test is practically the best test for predicting difficult airway. However, combining this test with upper lip bite test, thyromental distance and sternomental distance might result in better diagnostic accuracy.

Determining the Odds of Difficult Airway Resolution Among Pediatric Patients: A Case Series

2021 ◽  
pp. 019459982098657
Author(s):  
Edgar Erold Kiss ◽  
Patrick Olomu ◽  
Romaine F. Johnson
Keyword(s):  
Difficult Airway ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Case Series ◽  
Care Hospital ◽  
Mask Ventilation ◽  
Patient Factors ◽  
Hospital System ◽  
Lehane Grade ◽  
Difficult Airways

Objective We sought to determine the patient factors that contribute to the improvement and resolution of difficult airways in pediatric patients. Study Design The hospital’s Multidisciplinary Airway Registry Committee was created in November 2006 to develop a process for recognition and management of children with difficult airways. A database of these patients is actively maintained, allowing for statistical data analysis. Setting The tertiary care hospital system consists of 2 campuses serving the indigent pediatric population of the greater Dallas metropolitan area and performs an average of 40,000 anesthetic encounters per year. Methods We examined the data from a difficult airway database from a major tertiary care pediatric hospital to determine patient factors that led to airway improvement over time. Patients enrolled in the registry from November 2006 to October 2019 due to difficulties with intubation or mask ventilation were studied through statistical analysis. Results A total of 579 patients were identified. The Kaplan-Meier estimate of the 5-year deactivation rate was 14%. The most common reason for deactivation in our cohort was resolution of the difficult airway as defined by direct laryngoscopy Cormack and Lehane grade I or IIa/IIb, easy mask ventilation or laryngeal mask placement, or resolution of subglottic stenosis. Conclusion Advancing age and male sex at the time of enrollment were the most important predictors of an airway remaining difficult.

PERBEDAAN FINANCIAL PERFORMANCE PASCA SECONDARY OFFERINGS

Wahana ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 41-49
Author(s):  
Djaja Perdana ◽  
Herbowo Herbowo
Keyword(s):  
Financial Performance ◽  
Stock Exchange ◽  
Hypothesis Test ◽  
Poor Performance ◽  
Rank Test ◽  
Growth Ratio ◽  
Significant Difference ◽  
Before And After ◽  
Signed Rank Test ◽  
Asset Turnover

This study aims to examine the differences in corporate financial performance before and after secondary offerings. The financial performance is proxied by WCR, DER, Solvency, ROA, ROE, Asset Turnover (ATO) and Growth ratio which representing the value of liquidity, financing, activity, performance and growth of the firm. The study involved 67 samples of the companies listed on the Indonesia Stock Exchange conducting secondary offerings during 2008-2013 period and selected through purposive random sampling method and using Financial Statement data from 2005-2016 period. Hypothesis test is performed using Wilcoxon Signed Rank test. The results of this study indicate that there is no significant difference in the ratio of Solvency, ROA and ROE between before and after secondary offerings, but there are significant differences in the ratio of WCR, DER, Asset Turnover and Growth. WCR ratio after secondary offerings increased, while DER ratio after secondary offerings decreased, the condition of both ratios showed better performance. While the indication of poor performance seen in decreasing asset turnover ratio and growth ratio.Keywords : agency theory, financial performance, secondary offerings

The Degree of Subjective Complaints of Students Practice in Mechanical Technology Laboratories

2018 ◽  
Vol 4 (1) ◽  
pp. 22
Author(s):  
I Ketut Widana
Keyword(s):  
Engineering Students ◽  
Standing Position ◽  
Statistical Test ◽  
Rank Test ◽  
Cross Sectional ◽  
Signed Rank ◽  
Before And After ◽  
Signed Rank Test ◽  
The Difference ◽  
Paired T Test

The working practice of the engineering students is part of the learning process that is irreducible and indispensable. The composition of  lecturing between theoretical and practical one is 40% to 60%. With this condition, the students spend more time at the laboratory. Generally, the students perform in the laboratory work by standing position. The design of research is observational cross-sectional. The method applied is observation, interview and measuring. The subjects of research are practicing students amounting to 21 students. Referring to the analysis of statistical test or Wilcoxon signed ranks test, the difference of effect of work position is significant, namely p < 0.05 towards musculoskeletal disorders (MSDs) before and after working. The quantity of the average complaint after working is score 44.62 ± 9.47. The result of Wilcoxon signed rank test shows that there is significant different effects of standing work position, namely p < 0.05 towards fatigue generally before and after working. The degree of the working pulse is on the average of 110.78  ± 17.80 bpm (beats per minutes) which can be categorized into the medium workload. Using paired t-test, the result is p < 0.05.

scholarly journals A preliminary study on diabetes self-management education and glycemic control among patients with diabetes mellitus

2019 ◽  
Vol 9 (9) ◽  
pp. 98 ◽  
Author(s):  
Kisokanth G. ◽  
Indrakumar J. ◽  
Prathapan S. ◽  
Joseph J. ◽  
Ilankoon I.M.P.S.
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Management Education ◽  
Self Management ◽  
Rank Test ◽  
Diabetic Patients ◽  
Effective Measure ◽  
Before And After ◽  
Patients With Diabetes ◽  
Preliminary Study

This study was aimed to assess the effectiveness of diabetes self-management education (DSME) in the improvement of glycemic control among patients with type 2 Diabetes Mellitus (T2DM) in Batticaloa District, Sri Lanka. The study was a prospective interventional study and conducted as a preliminary study at medical clinic, Base hospital, Kaluwanchikudy, Batticaloa. Thirty patients with T2DM were included based on inclusion and exclusion criteria. A structured individual diabetes self-management education for 10 hours (one hour per week) was delivered to diabetic patients by the trained Nurse Health Educator. Glycosylate hemoglobin (HbA1c) was assessed as a main outcome measure and Fasting Blood Sugar (FBS), Body Mass Index (BMI) of each patient were also measured and recorded before and after the intervention. The respondent rate was 96.7% (n = 29). Majority of them were females (n = 25, 86.2%). A Wilcoxon signed rank test showed that DSME had a statistically significant reduction in HbA1c [8.60 (IQR 2.60) vs. 7.40 (IQR 2.10), p = .000] and FBS level [159.00 (IQR 77.50) vs. 134.00 (IQR 40.50), p = .002] at 3 months of intervention. The mean BMI at baseline was higher compared to 3 months of intervention [24.88 (SD ± 3.06) vs. 24.19 (SD ± 2.79)] which was statistically significant (p = .000). Majority of participants (n = 22, 75.9%) had improved their HbA1c level by ≥ 0.5% in 3 months. The diabetes self-management education is an effective measure in improving glycemic control and other clinical parameters among patients with T2DM. Thus, DSME needs to be implemented among clinic patients with T2DM for the better outcome and the preventions of complications.

The potential role of an activity-based guitar program on the anxiety and fulfillment levels of younger relatives of cancer patients: A pilot study

2021 ◽  
pp. 025576142110273
Author(s):  
Erkan Sülün ◽  
Hüseyin Olgaçer ◽  
Hakkı Cengiz Eren
Keyword(s):  
Cancer Patients ◽  
Trait Anxiety ◽  
Potential Role ◽  
Rank Test ◽  
Satisfaction Scale ◽  
Before And After ◽  
Signed Rank Test ◽  
Total State ◽  
Rank Differences

In this study, the authors evaluated the potential role of an activity-based guitar training program on reducing anxiety and providing fulfillment for younger relatives of cancer patients. Ten active members of KHYD (The Society for Relatives of Cancer Patients), between ages 11 and 17 participated in an 8-week guitar education program. The participants filled out two questionnaires before and after their engagement in the 8-week program, one to measure changes in their anxiety levels (State-Trait Anxiety Inventory) and the other to measure changes in their general fulfillment levels (Multidimensional Students’ Life Satisfaction Scale). Wilcoxon signed rank test, as well as descriptive statistics were used in the analysis of data. Mean rank differences were observed to be statistically significant with respect to total state and trait anxiety scores; in both cases, the participants’ scores decreased after their engagement in the program. Statistically significant mean rank differences were also observed in the overall MSLSS scores and its “friends” and “environment” sub-dimensions; with respect to these, participants’ scores increased after their engagement in the program. Recommendations for more comprehensive, larger-scale studies are given at the end.

scholarly journals MR-guided focused ultrasound liquid biopsy enriches circulating biomarkers in patients with brain tumors

2021 ◽  
Author(s):  
Ying Meng ◽  
Christopher B Pople ◽  
Suganth Suppiah ◽  
Maheleth Llinas ◽  
Yuexi Huang ◽  
...  
Keyword(s):  
Liquid Biopsy ◽  
Focused Ultrasound ◽  
Brain Regions ◽  
Specific Protein ◽  
Rank Test ◽  
Open Label ◽  
Isocitrate Dehydrogenase 1 ◽  
Serious Adverse Events ◽  
Before And After ◽  
Bbb Opening

Abstract Background Liquid biopsy is promising for early detection, monitoring of response and recurrence of cancer. The blood-brain barrier (BBB) limits the shedding of biomarker, such as cell-free DNA (cfDNA), into the blood, and their detection by conventional assays. Transcranial MR-guided focused ultrasound (MRgFUS) can safely and transiently open the BBB, providing an opportunity for less-invasive access to brain pathology. We hypothesized MRgFUS can enrich the signal of circulating brain-derived biomarkers to aid in liquid biopsy. Methods Nine patients were treated in a prospective single-arm, open-label trial to investigate serial MRgFUS and adjuvant temozolomide combination in patients with glioblastoma (NCT03616860). Blood samples were collected as an exploratory measure within the hours before and after sonication, with control samples from non-brain tumor patients undergoing BBB opening alone (NCT03739905). Results Brain regions averaging 7.8±6.0 cm 3 (range 0.8–23.1 cm 3) were successful treated within 111±39 minutes without any serious adverse events. We found MRgFUS acutely enhanced plasma cfDNA (2.6±1.2 fold, p&lt;0.01, Wilcoxon signed-rank test), neuron-derived extracellular vesicles (3.2±1.9 fold, p&lt;0.01), and brain specific protein S100b (1.4±0.2 fold, p&lt;0.01). Further comparison of the cfDNA methylation profiles suggests a signature that is disease and post-BBB opening specific, in keeping with our hypothesis. We also found cfDNA mutant copies of isocitrate dehydrogenase 1 (IDH1) increased, although this was in only one patient known to harbour the tumor mutation. Conclusions This first-in-human proof-of concept study shows MRgFUS enriches the signal of circulating brain-derived biomarkers, demonstrating the potential of the technology to support liquid biopsy for the brain.

scholarly journals Comparative Evaluation of Adenoids, Upper Airway, and Tongue Using “Predictors of Difficult Airways” in Class II Division 1 and Division 2 Cases with Class I Cases: Prospective In Vivo Observational Study

2021 ◽  
pp. 030157422096341
Author(s):  
Smita Mangesh Choudhari ◽  
Sunita Shrivastav
Keyword(s):  
Significant Positive Correlation ◽  
Upper Airway ◽  
Class Ii ◽  
Class I ◽  
Positive Correlation ◽  
Division 1 ◽  
Difficult Airways ◽  
Mandibular Protrusion ◽  
Division 2 ◽  
Class Ii Division 1

Introduction: Altered nasorespiratory function leads to altered craniofacial growth. Thus, airway evaluation is important for preventive, interceptive, and corrective orthodontic treatment. The aim of this study was to evaluate and compare adenoids, the upper airway, the tongue, and mandibular dimensions using “predictors of difficult airways” in class II division 1 and class II division 2 cases with class I cases. Method: Sixty subjects of age 15 to 18 years were divided into 3 groups (group 1: class I cases; group 2: class II division 1 cases; and group 3: class II division 2 cases) based on cephalometric parameters, with 20 cases in each group. Cephalometric evaluation of adenoids and the nasopharyngeal airway was done using the Handelman–Osborne area method. Upper and lower airway evaluation was done using McNamara’s linear method. “Predictors of difficult airways” were used for evaluation of the airway, which included nasal competency, the Mallampati scale, mandibular length, mandibular protrusion, and the thyromental distance. Results: The present study found a significant positive correlation between the grades of nasal competency and percentage adenoid wall area, and a significant negative correlation between the grades of nasal competency and the upper airway. There was a significant positive correlation between the grades of nasal competency and mandibular length, and a significant positive correlation between the grades of mandibular protrusion and mandibular length. There was a significant positive correlation between the grades of the thyromental distance and mandibular length. Conclusion: It was concluded that the “predictors of difficult airways” would be helpful in early diagnosis and identification of potential risk factors that may cause “breathing disorders”–related malocclusions and later on increase the risk of developing OSA.

scholarly journals Developmental features and predicting airway failure risk in critically ill children with mandibular hypoplasia using 3D computational tomographic analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Doo-Hwan Kim ◽  
Eunseo Gwon ◽  
Junheok Ock ◽  
Jong-Woo Choi ◽  
Jee Ho Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Difficult Airway ◽  
Hyoid Bone ◽  
Three Dimensional ◽  
Upper Airway ◽  
Critically Ill Children ◽  
Healthy Controls ◽  
Mandibular Hypoplasia ◽  
Tongue Position ◽  
Developmental Features

AbstractIn children with mandibular hypoplasia, airway management is challenging. However, detailed cephalometric assessment data for this population are sparse. The aim of this study was to find risk factors for predicting difficult airways in children with mandibular hypoplasia, and compare upper airway anatomical differences using three-dimensional computed tomography (3D CT) between children with mandibular hypoplasia and demographically matched healthy controls. There were significant discrepancies in relative tongue position (P < 0.01) and anterior distance of the hyoid bone (P < 0.01) between patients with mandibular hypoplasia and healthy controls. All mandibular measures were significantly different between the two groups, except for the height of the ramus of the mandible. After adjusting for age and sex, the anterior distance of hyoid bone and inferior pogonial angle were significantly associated with a difficult airway (P = 0.01 and P = 0.02). Quantitative analysis of upper airway structures revealed significant discrepancies, including relative tongue position, hyoid distance, and mandible measures between patients with mandibular hypoplasia and healthy controls. The anterior distance of the hyoid bone and inferior pogonial angle may be risk factors for a difficult airway in patients with mandibular hypoplasia.

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