Preanaesthetic airway assessment may extend to glottis visualisation: An evaluation of intubation difficulty scale at laryngoscopy by two different blades. Your Title here

The purpose of this study was to determine changes in the hypoglossal nerve function after suspension laryngoscopy with needle electromyography of the tongue. This study also attempted to determine the possible relationship between the predictive factors of intubation difficulty by using the intubation difficulty scale, which was introduced by Adnet et al., duration of suspension laryngoscopy and changes in hypoglossal nerve function after suspension laryngoscopy. The study was performed on 39 patients who underwent suspension laryngoscopy for benign glottic pathology. Pre-operative airway assessment was evaluated by the intubation difficulty scale and the duration of suspension laryngoscopy was recorded. Needle electromyography of the tongue was performed three or four weeks after the suspension laryngoscopy. After needle electromyography of the tongue, increased polyphasia was found in 13 patients (33 per cent), bilaterally in three of them. The interference pattern was reduced in two of these 13 patients. There was no statistically significant difference in predictive factors of intubation difficulty and the duration of the operation between these 13 patients with increased polyphasiaand the remaining 26 patients with completely normal electromyography findings. These findings show that, in spite of normal clinical tongue function, subclinical changes can be detected by needle electromyography of the tongue after suspension laryngoscopy.

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Short Neck, a new criterion for airway assessment A pilot, cohort single blind study

10.21203/rs.2.19970/v1 ◽

2020 ◽

Author(s):

jafar faraj ◽

Yasir E. Ahmed ◽

Chetankumar B. Raval ◽

Taisir M Yousif ◽

Neeraj Kumar ◽

...

Keyword(s):

Elective Surgery ◽

P Value ◽

Short Neck ◽

Neck Length ◽

Intubation Difficulty ◽

Airway Assessment ◽

Difficulty Scale ◽

Group B ◽

Difficulty Score ◽

New Criterion

Abstract Purpose Short Neck is a term used by anesthesiologists to describe one of the risk factors for difficult airway management. However, the term Short Neck is very subjective and has not been standardized. We attempt to quantify Short Neck.Methods A pilot prospective single blinded study was conducted at Hamad General Hospital, Doha, Qatar between March 2018 and October 2018. 97 adult patients scheduled for elective surgery under general anesthesia were recruited. Measurements of airway assessment, including neck length, were documented prior to anesthesia. The operators (anesthesiologists) were blinded. Intubation Difficulty Scale was used. All data were documented and analysed afterwards. Patients were of three groups according to Intubation Difficulty Scale (IDS): Group A: IDS 0, Group B: IDS >0 - ≤5 and Group C: IDS >5.Results Five patients (5.2%) with intubation difficulty score >5 have a mean neck length 7.6 cm. Short Neck was found to have a significant p value 0.022 within the three groups.Conclusions Patient's features relevant to airway assessment are rather difficult to quantify. This is the first reported attempt to obtain an objective value for Short Neck in routine airway assessment.

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Predictors of difficult intubation defined by the intubation difficulty scale (IDS): predictive value of 7 airway assessment factors

Korean Journal of Anesthesiology ◽

10.4097/kjae.2012.63.6.491 ◽

2012 ◽

Vol 63 (6) ◽

pp. 491 ◽

Cited By ~ 21

Author(s):

Suk-Hwan Seo ◽

Jeong-Gil Lee ◽

Soo-Bong Yu ◽

Doo-Sik Kim ◽

Sie-Jeong Ryu ◽

...

Keyword(s):

Difficult Intubation ◽

Predictive Value ◽

Intubation Difficulty ◽

Airway Assessment ◽

Difficulty Scale

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Determination of the utility of the Intubation Difficulty Scale for use with indirect laryngoscopes

Anaesthesia ◽

10.1111/j.1365-2044.2011.06891.x ◽

2011 ◽

Vol 66 (12) ◽

pp. 1127-1133 ◽

Cited By ~ 14

Author(s):

J. McElwain ◽

A. Simpkin ◽

J. Newell ◽

J. G. Laffey

Keyword(s):

Intubation Difficulty ◽

Difficulty Scale

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Comparison of Laryngoscopic Views between C-MAC™ and Conventional Laryngoscopy in Patients with Multiple Preoperative Prognostic Criteria of Difficult Intubation. An Observational Cross-Sectional Study

Medicina ◽

10.3390/medicina55120760 ◽

2019 ◽

Vol 55 (12) ◽

pp. 760

Author(s):

Aikaterini Amaniti ◽

Panagiota Papakonstantinou ◽

Dimitrios Gkinas ◽

Ioannis Dalakakis ◽

Evangelia Papapostolou ◽

...

Keyword(s):

Prognostic Factors ◽

Difficult Intubation ◽

Elective Surgery ◽

Significant Risk ◽

Significant Risk Factor ◽

Cross Sectional Study ◽

Laryngoscopic View ◽

Cross Sectional ◽

Intubation Difficulty ◽

Difficulty Scale

Background and Objectives: Video laryngoscopy has been proven useful under difficult airway scenarios, but it is unclear whether anticipated improvement of visualization is related to specific difficult intubation prognostic factors. The present study evaluated the change in laryngoscopic view between conventional and C-MAC® laryngoscopy and the presence of multiple difficult intubation risk factors. Materials and Methods: Patients scheduled for elective surgery with >2 difficult intubation factors, (Mallampati, thyromental distance (TMD), interinscisor gap, buck teeth, upper lip bite test, cervical motility, body mass index (BMI)) were eligible. Patients underwent direct laryngoscopy (DL) followed by C-MAC™ laryngoscopy (VL) and intubation. Change of view between DL and VL, time for best view, intubation difficulty scale (IDS) and correlation between prognostic factors, laryngoscopic view improvement, and IDS were measured. Results: One-hundred and seventy-six patients completed the study. VL lead to fewer Cormarck–Lehane (C/L) III-IV, compared to DL (13.6% versus 54.6%, p < 0.001). The time to best view was also shorter (VL: 10.82 s, DL: 12.08 s, p = 0.19). Mallampati III-IV and TMD ≤ 6 cm were related to improvement of C/L between DL and VL. Logistic regression showed these two factors to be a significant risk factor of the glottis view change (p = 0.006, AUC-ROC = 0.57, 95% CI: 0.47–0.66). 175/176 patients were intubated with VL. 108/176 were graded as 0 < IDS ≤ 5 and 12/176 as IDS > 5. IDS was only correlated to the VL view (p < 0.0001). Conclusion: VL improved laryngoscopic view in patients with multiple factors of difficult intubation. Mallampati and TMD were related to the improved view. However, intubation difficulty was only related to the VL view and not to prognostic factors.

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Neutral Position Facilitates Nasotracheal Intubation with a GlideScope Video Laryngoscope: A Randomized Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm9030671 ◽

2020 ◽

Vol 9 (3) ◽

pp. 671

Author(s):

RyungA Kang ◽

Ji Seon Jeong ◽

Justin Sangwook Ko ◽

Jaemyung Ahn ◽

Mi Sook Gwak ◽

...

Keyword(s):

Controlled Trial ◽

Nasotracheal Intubation ◽

Head Position ◽

Neutral Position ◽

Dental Surgery ◽

Intubation Difficulty ◽

Difficulty Scale ◽

Nasotracheal Tube ◽

Glidescope Video Laryngoscope ◽

Position Group

The optimal head position for GlideScope facilitated nasotracheal intubation has not yet been determined. We compared the neutral and sniffing positions to establish the degree of intubation difficulty. A total of 88 ASA I-II patients requiring nasotracheal intubation for elective dental surgery with normal airways were divided into two groups according to head position, neutral position (group N), and sniffing position (group S). The primary outcome was the degree of intubation difficulty according to the Intubation Difficulty Scale (IDS): Easy (IDS = 0), mildly difficult (IDS = 1 to 4), and moderately to severely difficult (IDS ≥ 5). Eighty-seven patients completed the study and their data were analyzed. The degree of intubation difficulty was significantly different between the two groups (p = 0.004). The frequency of difficult intubation (IDS > 0) was 12 (27.9%) in group N and 28 (63.6%) in group S (difference in proportion, 35.7%; 95% confidence interval [CI], 14.8 to 52.6%; p = 0.001). The neutral position facilitates nasotracheal intubation with GlideScope by aligning the nasotracheal tube and the glottis inlet more accurately than the sniffing position.

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Effectiveness of an Advanced Airway Training “Boot Camp” for Family Medicine Physician Trainees

Otolaryngology ◽

10.1177/0194599820902065 ◽

2020 ◽

Vol 163 (2) ◽

pp. 204-208 ◽

Cited By ~ 1

Author(s):

Kastley Marvin ◽

Paige Bowman ◽

Matthew W. Keller ◽

Art A. Ambrosio

Keyword(s):

Family Medicine ◽

Airway Management ◽

Family Medicine Residency ◽

Training Course ◽

Intubation Difficulty ◽

Advanced Airway ◽

Medicine Physician ◽

Hands On ◽

Difficulty Scale ◽

The Impact

Objective This course was designed to characterize the impact of a curriculum for training family medicine physicians in advanced airway techniques with respect to intubation performance and learner confidence. Methods A training course was introduced into the curriculum in a single-group pretest-posttest model at a community family medicine residency program. Training consisted of a didactic teaching session on airway management and hands-on skill session with direct laryngoscopy (DL) and video-assisted laryngoscopy (VAL) on normal and difficult airway simulators. Participants were scored with the Intubation Difficulty Scale and completed surveys before and after the training. Results Twenty-eight residents of all levels participated. The mean time to successful intubation was significantly decreased after training from 51.96 to 23.71 seconds for DL and from 27.89 to 17.07 seconds for VAL. Participant scores with the Intubation Difficulty Scale were also significantly improved for DL and VAL. All participants rated their comfort levels with both techniques as high following training. Discussion Advanced airway management is a critical skill for any physician involved in caring for critically ill patients, though few trainees receive formal training. Addition of an airway training course with simulation and hands-on experience can improve trainee proficiency and comfort with advanced airway techniques. Implications for Practice Training on airway management should be included in the curriculum for trainees who require the requisite skills and knowledge necessary for advanced airway interventions. This introductory project demonstrates the efficacy and feasibility of a relatively brief training as part of a family medicine residency curriculum.

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