scholarly journals Effect of Head Elevation to Different Heights in Laryngeal Exposure with Direct Laryngoscopy

2019 ◽  
Vol 17 (2) ◽  
pp. 168-172
Author(s):  
Pragya Acharya ◽  
Anil Shrestha ◽  
Arjun Gurung ◽  
Megha Koirala ◽  
Gentle Sundar Shrestha ◽  
...  
Keyword(s):  
Direct Laryngoscopy ◽  
Elective Surgery ◽  
Difficult Laryngoscopy ◽  
Adult Patients ◽  
Laryngoscopic View ◽  
Head Elevation ◽  
Laryngeal Exposure ◽  
Lehane Grade ◽  
Induction Of Anaesthesia ◽  
Grade Iii

Background: The purpose of this study was to determine the optimal pillow height for the best laryngoscopic view in adult patients scheduled for elective surgery under general anaesthesia.Methods: 150 adult patients undergoing surgery under general anaesthesia with endotracheal intubation with no features suggestive of difficult airway were enrolled for the study. After induction of anaesthesia the assessment of direct laryngoscopic views was done at head positions without a pillow and with non-compressible pillows of heights 5cm and 10cm.Results: The laryngoscopic view with the 5cm pillow was significantly superior to other head position (p<0.01). The incidence of difficult laryngoscopy (Cormack and Lehane grade III) was 32.7% without a pillow which improved to (Cormack and Lehane grade III) 4% with 10cm pillow and there were no cases of difficult laryngoscopy with 5cm pillow.Conclusions: The use of 5cm pillow in the ‘sniffing’ position obtains the best laryngoscopic view during direct laryngoscopy.Keywords: Direct laryngoscopy; head elevation; laryngoscopicview; pillow height.

scholarly journals McGrath Video Laryngoscope May Take a Longer Intubation Time Than Macintosh Laryngoscope

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Prerana N. Shah ◽  
Kaveri Das
Keyword(s):  
Randomized Study ◽  
Macintosh Laryngoscope ◽  
Total Duration ◽  
Video Laryngoscope ◽  
Intubation Time ◽  
Laryngoscopic View ◽  
Lehane Grade ◽  
Secondary Endpoints ◽  
Grade Ii ◽  
Grade Iii

Background. Video laryngoscopes provide better view and can improve ease of intubation compared with standard laryngoscopes. Methods. A prospective randomized study was done on 60 patients, 18 to 65 years old, comparing McGrath video laryngoscope and Macintosh laryngoscope. The aim was to compare the ease, efficacy, and usability of them during routine airway management. The primary endpoint was duration of intubation and the secondary endpoints were Cormack and Lehane grade of laryngoscopic view, number of intubation attempts, and incidence of complications. Results. There was an increase in total duration of intubation with McGrath video laryngoscope with 42.9 ± 19.5 seconds compared to Macintosh laryngoscope with 17.9 ± 4.6 seconds. In Macintosh group, 73.3% had grade I, 20% had grade II, and 6.7% had grade III Cormack Lehane view, while in McGrath group, 83.3% had grade I, 13.3% had grade II, and 3.3% had grade III. In McGrath group, 6 patients (20%) required more than 120 seconds to get intubated and only 73.3% were intubated in 1 attempt, while patients in Macintosh group had 100% successful intubation in 1 attempt. Pharyngeal trauma was seen with McGrath videolaryngoscopy. Conclusion. Duration of laryngoscopy, intubation, and total duration of intubation were significantly higher in McGrath group than in Macintosh group. McGrath group required a higher number of intubation attempts.

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.

Difficult Intubation in Acromegalic Patients

2000 ◽  
Vol 93 (1) ◽  
pp. 110-114 ◽  
Author(s):  
Hubert Schmitt ◽  
Michael Buchfelder ◽  
Martin Radespiel-Tröger ◽  
Rudolf Fahlbusch
Keyword(s):  
Difficult Intubation ◽  
Preoperative Assessment ◽  
Difficult Laryngoscopy ◽  
Fisher Exact Test ◽  
Muscle Paralysis ◽  
Exact Test ◽  
Number Of Patients ◽  
Lehane Grade ◽  
Grade Ii ◽  
Grade Iii

Background Previous studies have suggested that the incidence of difficult intubation in acromegalic patients is higher than in normal patients. However, these studies were retrospective and did not include preoperative assessment of the airways. The aims of this study were to determine the incidence of difficult intubation and to assess the usefulness of preoperative tests in predicting difficult laryngoscopy. Methods One hundred twenty-eight consenting acromegalic patients requiring general anesthesia and tracheal intubation were studied. Preoperatively, Mallampati classification, thyromental distance, and head and neck movement were determined in each patient. After induction of anesthesia and muscle paralysis, laryngoscopic grade was assessed during direct laryngoscopy; Cormack and Lehane grade III or IV were classified as difficult. The association of individual airway assessment with laryngeal view was evaluated using the Fisher exact test. Predictors of difficult laryngoscopy were evaluated by calculating their sensitivity and specificity. Results Laryngoscopy was difficult (grade III) in 33 of 128 patients (26%). Application of external laryngeal pressure improved laryngeal visualization to grade II in 20 of these 33 patients. In the remaining 13 patients (10%), intubation was difficult (more than two attempts, blade change, use of gum-elastic bougie). Mallampati classes 3 and 4 were significantly related to laryngoscopy grade III (Fisher exact test, P = 0.001). Conclusions The incidence of difficult laryngoscopy and intubation in acromegalic patients is higher than in normal patients. Preoperative Mallampati scores of 3 and 4 were of value in predicting difficult laryngoscopy. Nevertheless, even this test will miss a significant number of patients with a difficult airway.

Cricoid Pressure Does Not Increase the Rate of Failed Intubation by Direct Laryngoscopy in Adults

2005 ◽  
Vol 102 (2) ◽  
pp. 315-319 ◽  
Author(s):  
Alexis F. Turgeon ◽  
Pierre C. Nicole ◽  
Claude A. Trépanier ◽  
Sylvie Marcoux ◽  
Martin R. Lessard
Keyword(s):  
Scale Score ◽  
Direct Laryngoscopy ◽  
Cricoid Pressure ◽  
Anesthesia Induction ◽  
Intubation Time ◽  
Failed Intubation ◽  
Laryngoscopic View ◽  
Intubation Difficulty ◽  
Lehane Grade ◽  
Difficulty Scale

Background Cricoid pressure (CP) is applied during induction of anesthesia to prevent regurgitation of gastric content and pulmonary aspiration. However, it has been suggested that CP makes tracheal intubation more difficult. This double-blind randomized study evaluated the effect of CP on orotracheal intubation by direct laryngoscopy in adults. Methods Seven hundred adult patients undergoing general anesthesia for elective surgery were randomly assigned to have a standardized CP (n = 344) or a sham CP (n = 356) during laryngoscopy and intubation. After anesthesia induction and complete muscle relaxation, a 30-s period was allowed to complete intubation with a Macintosh No. 3 laryngoscope blade. The primary endpoint was the rate of failed intubation at 30 s. The secondary endpoints included the intubation time, the Cormack and Lehane grade of laryngoscopic view, and the Intubation Difficulty Scale score. Results Groups were similar for demographic data and risk factors for difficult intubation. The rates of failed intubation at 30 s were comparable for the two groups: 15 of 344 (4.4%) and 13 of 356 (3.7%) in the CP and sham CP groups, respectively (P = 0.70). The grades of laryngoscopic view and the Intubation Difficulty Scale score were also comparable. Median intubation time was slightly longer in the CP group than in the sham CP group (11.3 and 10.4 s, respectively, P = 0.001). Conclusions CP applied by trained personnel does not increase the rate of failed intubation. Hence CP should not be avoided for fear of increasing the difficulty of intubation when its use is indicated.

Head elevation improves laryngeal exposure with direct laryngoscopy

2015 ◽  
Vol 27 (2) ◽  
pp. 153-158 ◽  
Author(s):  
Mohammad I. El-Orbany ◽  
Yohannes B. Getachew ◽  
Ninos J. Joseph ◽  
M. Ramez Salem ◽  
Michael Friedman
Keyword(s):  
Direct Laryngoscopy ◽  
Head Elevation ◽  
Laryngeal Exposure

Randomized Study Comparing the “Sniffing Position” with Simple Head Extension for Laryngoscopic View in Elective Surgery Patients

2001 ◽  
Vol 95 (4) ◽  
pp. 836-841 ◽  
Author(s):  
Frédéric Adnet ◽  
Christophe Baillard ◽  
Stephen W. Borron ◽  
Christophe Denantes ◽  
Laurent Lefebvre ◽  
...  
Keyword(s):  
Direct Laryngoscopy ◽  
Elective Surgery ◽  
Randomized Study ◽  
Orotracheal Intubation ◽  
Simple Extension ◽  
Laryngoscopic View ◽  
Head Extension ◽  
Group A ◽  
Group B ◽  
Neck Mobility

Background The "sniffing position" is recommended for optimization of glottic visualization under direct laryngoscopy. However, no study to date has confirmed its superiority over simple head extension. In a prospective, randomized study, the authors compared the sniffing position with simple head extension in orotracheal intubation. Methods The study included 456 consecutive patients. The sniffing position was obtained by placement of a 7-cm cushion under the head of the patient. The extension position was obtained by simple head extension. The anesthetic procedure included two Laryngoscopies without paralysis: the first was used for topical glottic anesthesia. During the second direct laryngoscopy, intubation of the trachea was performed. The head position was randomized as follows: group A was in the sniffing position during the first Laryngoscopy and the extension position during the second, group B was in the extension position during the first laryngoscopy and the sniffing position during the second. Glottic exposure was assessed by the Cormack scale. Results The sniffing position improved glottic exposure (decreased the Cormack grade) in 18% of patients and worsened it (increased the Cormack grade) in 11% of patients, in comparison with simple extension. The Cormack grade distribution was not significantly modified between the two groups. Multivariate analysis showed that reduced neck mobility and obesity were independently related to improvement in laryngoscopic view with application of the sniffing position. Conclusions Routine use of the sniffing position appears to provide no significant advantage over simple head extension for tracheal intubation in this setting. The sniffing position appears to be advantageous in obese and head extension-limited patients.

scholarly journals The “BURP” maneuver improves the glottic view during laryngoscopy but remains a difficult procedure

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092532
Author(s):  
Tao Yu ◽  
Rong-rong Wu ◽  
Federico Longhini ◽  
Bin Wang ◽  
Ming-fang Wang ◽  
...  
Keyword(s):  
Difficult Intubation ◽  
Area Under The Curve ◽  
Difficult Laryngoscopy ◽  
Laryngoscopic View ◽  
Glottic View ◽  
Mallampati Score ◽  
Lehane Grade ◽  
Difficult Procedure ◽  
Interincisor Distance ◽  
Grade 3

Objective We investigated the “BURP” maneuver’s effect on the association between difficult laryngoscopy and difficult intubation, and predictors of a difficult airway. Methods Adult patients who underwent general anesthesia and tracheal intubation from September 2016 to May 2018 were included. The “BURP” maneuver was performed when glottic exposure was classified as Cormack–Lehane grade 3 or 4, suggesting difficult laryngoscopy. The thyromental distance, modified Mallampati score, and interincisor distance were assessed before anesthesia. Results Among this study’s 2028 patients, the “BURP” maneuver decreased difficult laryngoscopies from 428 (21.1%) to 124 (6.1%) cases and increased the difficult intubation to difficult laryngoscopy ratio from 53/428 (12.4%) to 52/124 (41.9%). For laryngoscopies classified as difficult without the “BURP” maneuver, the area under the curve (AUC) of the thyromental distance, modified Mallampati score, and interincisor distance was 0.60, 0.57, and 0.66, respectively. In difficult laryngoscopies using the “BURP” maneuver, the AUC of the thyromental distance, modified Mallampati score, and interincisor distance was 0.71, 0.67, and 0.76, respectively. Conclusions The “BURP” maneuver improves the laryngoscopic view and assists in difficult laryngoscopies. Compared with difficult laryngoscopies without the “BURP” maneuver, those with the “BURP” maneuver are more closely associated with difficult intubations and are more predictable. Trial registration: www.chictr.org.cn identifier: ChiCTR-ROC- 16009050.

scholarly journals Prediction of Difficult Laryngoscopy: An Assessment of the Thyromental Distance and Mallampati Predictive Tests

1992 ◽  
Vol 20 (2) ◽  
pp. 139-142 ◽  
Author(s):  
P. J. Butler ◽  
S. S. Dhara
Keyword(s):  
Direct Laryngoscopy ◽  
False Positive ◽  
Difficult Laryngoscopy ◽  
Predictive Tests ◽  
Induction Of Anaesthesia

Two hundred and fifty patients were assessed preoperatively using the Mallampati classification and by measuring their thyromental distances. The ease or difficulty of direct laryngoscopy was assessed at the time of induction of anaesthesia. Retrognathia was seen in 15.6% of patients and the incidence of difficult laryngoscopy without external laryngeal pressure was 8.2%. It was found that both assessments predicted less than two in three difficult laryngoscopies and had high false positive rates. It was found that external laryngeal pressure often improved the view of the glottis in difficult laryngoscopies.

Difficult Laryngoscopy/Intubation: The Child with Mandibular Hypoplasia

1983 ◽  
Vol 92 (4) ◽  
pp. 401-404 ◽  
Author(s):  
Steven D. Handler ◽  
Thomas P. Keon
Keyword(s):  
Temporomandibular Joint ◽  
Direct Laryngoscopy ◽  
Anterior Commissure ◽  
Difficult Laryngoscopy ◽  
Treacher Collins Syndrome ◽  
Pierre Robin Sequence ◽  
Hemifacial Microsomia ◽  
Mandibular Hypoplasia ◽  
Pierre Robin ◽  
Infants And Young Children

The child with mandibular hypoplasia (Treacher Collins syndrome, Pierre Robin sequence, hemifacial microsomia, etc) presents the otolaryngologist and anesthesiologist with considerable problems when direct laryngoscopy and/or endotracheal intubation is attempted. In addition to the small mandible, several other features of these patients contribute to the difficult laryngoscopy: macroglossia, glossoptosis, trismus related to temporomandibular joint abnormalities, and prominent maxilla or maxillary incisors. Most of the techniques that have been described for laryngoscopy/intubation in problem cases are difficult or impossible to use in infants and young children with mandibular hypoplasia. We present a modification of the standard direct laryngoscopic procedure, utilizing the 9-cm anterior commissure laryngoscope and an optical stylet in the task of exposing and intubating the larynx of a child with mandibular hypoplasia.

Mandibular Advancement Improves the Laryngeal View during Direct Laryngoscopy Performed by Inexperienced Physicians

2004 ◽  
Vol 100 (3) ◽  
pp. 598-601 ◽  
Author(s):  
Miki Tamura ◽  
Teruhiko Ishikawa ◽  
Rie Kato ◽  
Shiroh Isono ◽  
Takashi Nishino
Keyword(s):  
Direct Laryngoscopy ◽  
Statistical Difference ◽  
Elective Surgery ◽  
Muscle Relaxation ◽  
Mandibular Advancement ◽  
Friedman Test ◽  
Rating Score ◽  
Laryngeal View ◽  
Statistical Comparison ◽  
The Third

Background When oral or nasal fiberoptic laryngoscopy is attempted, mandibular advancement has been reported to improve the laryngeal view. The authors hypothesized that mandibular advancement may also improve the laryngeal view during direct laryngoscopy. Methods Forty patients undergoing elective surgery under general anesthesia were included in this study. After establishment of an adequate level of anesthesia and muscle relaxation, direct laryngoscopy was performed by inexperienced physicians. Four different maneuvers--simple direct laryngoscopy without any assistance (C), simple direct laryngoscopy with mandibular advancement (M), simple direct laryngoscopy with the BURP maneuver (backward, upward, rightward pressure maneuver of the larynx; B), and simple direct laryngoscopy with both mandibular advancement and the BURP maneuver (BM)--were attempted in each subject, and the laryngeal aperture was videotaped with each procedure. An instructor in anesthesiology who was blinded to the procedure evaluated the visualization by reviewing videotape off-line, using the Cormack-Lehane classification system (grades I-IV) and a rating score within each subject (1 = best view; 4 = poorest view). The Friedman test followed by the Student-Newman-Keuls test was performed for statistical comparison. P &lt; 0.05 was considered significant. Results The laryngeal view was improved with M and B when compared with C (P &lt; 0.05 by both rating and Cormack-Lehane evaluation). BM was the most effective method to visualize the laryngeal aperture (P &lt; 0.05, vs. B and M by rating evaluation), whereas B and M were the second and the third most effective methods, respectively. No statistical difference was observed between B and M with the Cormack-Lehane classification. Conclusion Mandibular advancement improves the laryngeal view during direct laryngoscopy performed by inexperienced physicians.

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