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.

scholarly journals Intraoperative hand strength as an indicator of consciousness during awake craniotomy: a prospective, observational study

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Chinatsu Umaba ◽  
Yohei Mineharu ◽  
Nan Liang ◽  
Toshiyuki Mizota ◽  
Rie Yamawaki ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Awake Craniotomy ◽  
Hand Strength ◽  
Unaffected Side ◽  
Brain Functions ◽  
Level Of Consciousness

AbstractAwake craniotomy enables mapping and monitoring of brain functions. For successful procedures, rapid awakening and the precise evaluation of consciousness are required. A prospective, observational study conducted to test whether intraoperative hand strength could be a sensitive indicator of consciousness during the awake phase of awake craniotomy. Twenty-three patients who underwent awake craniotomy were included. Subtle changes of the level of consciousness were assessed by the Japan Coma Scale (JCS). The associations of hand strength on the unaffected side with the predicted plasma concentration (Cp) of propofol, the bispectral index (BIS), and the JCS were analyzed. Hand strength relative to the preoperative maximum hand strength on the unaffected side showed significant correlations with the Cp of propofol (ρ =  − 0.219, p = 0.007), the BIS (ρ = 0.259, p = 0.002), and the JCS (τ =  − 0.508, p = 0.001). Receiver operating characteristic curve analysis for discriminating JCS 0–1 and JCS ≥ 2 demonstrated that the area under the curve was 0.76 for hand strength, 0.78 for Cp of propofol, and 0.66 for BIS. With a cutoff value of 75% for hand strength, the sensitivity was 0.76, and the specificity was 0.67. These data demonstrated that hand strength is a useful indicator for assessing the intraoperative level of consciousness during awake craniotomy.

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

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.

Ratio of height to thyromental distance: a comparison with Mallampati and Upper lip Bite test for predicting difficult intubation in Pakistani population

2021 ◽  
pp. 1-15
Author(s):  
Saman Tauheed Ali ◽  
Khalid Samad ◽  
Syed Amir Raza ◽  
Muhammad Qamarul Hoda
Keyword(s):  
Predictive Value ◽  
Characteristic Curve ◽  
Cross Sectional Study ◽  
Difficult Laryngoscopy ◽  
University Hospital ◽  
Upper Lip ◽  
Cross Sectional ◽  
Elective Surgical Procedures ◽  
Lehane Grade ◽  
Sensitivity Specificity

Objectives: We conducted this study to compare the accuracy of three diagnostic tests; ratio of height to thyromental distance (RHTMD), Modified Mallampati Test (MMT) and Upper Lip Bite Test (ULBT) in predicting difficult laryngoscopy using Cormack and Lehane grade as gold standard.Methods: This study was conducted in Aga Khan University Hospital, Karachi. Based on calculated sample size, 383 patients who required endotracheal intubation for elective surgical procedures were enrolled with consecutive sampling techniques during August 2014 to August 2015 for this cross-sectional study. Primary investigator used RHTMD, ULBT, and MMT for assessing the airway and correlated with laryngoscopic view.Results: A total of 383 patients were incorporated in this research, out of which 59(15.4%) classified as difficult laryngoscopy based on Cormack and Lehane (CL) grading. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of RHTMD (84.7%, 90.1%, 60.9%, 97%, 89.3%) and ULBT (83.1%, 89.2%, 58.3%, 96.7%, 88.3%) values were highest as compared to MMT (30.5%, 84.3%, 26.1%, 86.9%, 79.9%). The area under a receiver-operating characteristic curve (AUC of ROC curve) for ULBT and RHTMD was significantly more than for MMT (P<0.01). RHTMD and ULBT both are acceptable alternatives for prediction of difficult laryngoscopy as a simple, single bed-side test. Continuous...

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 Copeptin in the Differential Diagnosis of Hyponatremia

2009 ◽  
Vol 94 (1) ◽  
pp. 123-129 ◽  
Author(s):  
Wiebke Fenske ◽  
Stefan Störk ◽  
Anne Blechschmidt ◽  
Sebastian G. K. Maier ◽  
Nils G. Morgenthaler ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Prospective Observational Study ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Urine Osmolality ◽  
Close Correlation ◽  
Correct Treatment ◽  
Primary Polydipsia ◽  
Diagnostic Potential ◽  
Healthy Control

Abstract Background: Treatment of patients with hyponatremia varies widely; thus, convenient diagnostic parameters are needed to guide the correct treatment strategy. This study was designed to evaluate the diagnostic potential of copeptin, the C-terminal part of provasopressin, as a new marker in the differential diagnosis of hyponatremia. Methods: In this prospective observational study, 106 consecutive hyponatremic patients were classified based on their history, clinical evaluation, and laboratory tests. In patients and 32 healthy control subjects, plasma copeptin concentration and standard biochemical parameters were tested for their utility of diagnosing the syndrome of inappropriate antidiuresis (SIAD). Results: Four patients (4%) were diagnosed as primary polydipsia, nine (8%) as diuretic-induced hyponatremia, 42 (40%) as SIAD, 29 (27%) as hypovolemic hyponatremia, and 22 patients (21%) as hypervolemic hyponatremia. In controls, a close correlation between plasma copeptin and serum sodium (r2 = 0.62, P &lt; 0.001) or urine osmolality (r2 = 0.39, P = 0.001) was observed. Plasma copeptin levels were significantly higher in patients with hypo- and hypervolemic hyponatremia compared with SIAD (P &lt; 0.005, respectively) and primary polydipsia (P &lt; 0.001). The copeptin to U-Na ratio differentiated accurately between volume-depleted and normovolemic disorders (area under the receiver-operating characteristic curve 0.88, 95% confidence interval 0.81–0.95; P &lt; 0.001), resulting in a sensitivity and specificity of 85 and 87% if a cutoff value of 30 pmol/mmol was used. The combined information of plasma copeptin less than 3 pmol/liter and urine osmolality less than 200 mOsm/kg ensured primary polydipsia in 100% of suspected patients. Conclusion: Copeptin measurement reliably identifies patients with primary polydipsia but has limited utility in the differential diagnosis of other hyponatremic disorders. In contrast, the copeptin to U-Na ratio is superior to the reference standard in discriminating volume-depleted from normovolemic hyponatremic disorders.

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.

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