scholarly journals Comparative Evaluation of Difficult Intubation Predictors in Children Under Two Years of Ages

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Sedige Shahhosseini ◽  
Mohammad Montasery ◽  
Mohammadali Saadati ◽  
Amir Shafa
Keyword(s):  
Difficult Intubation ◽  
Comparative Evaluation ◽  
Analytical Study ◽  
Elective Surgery ◽  
Mouth Opening ◽  
Suprasternal Notch ◽  
Pediatric Airway ◽  
Intubation Difficulty ◽  
Difficulty Scale ◽  
Difficult Cases

Background: Tracheal intubation is the most reliable way of securing an airway. Pediatric airway management is one of the significant challenges, especially for non-pediatric anesthesiologists. Early airway evaluation for detecting difficult intubation and preventing catastrophic events is necessary before anesthesia, especially in children. Objectives: Therefore, this study was done to compare some valuable adult predictors in children under two years of age. Methods: This prospective descriptive-analytical study was performed on 405 children under two years of age that were referred for elective surgery under general anesthesia with endotracheal intubation in Imam Hossein Hospital, Isfahan. Under sedation in a supine position, we measured items, including age, weight, height, stern omental distance (SMD), mouth opening (MO), neck circumference (NC), acromio-axillo-suprasternal notch index (AASI), and intubation difficulty scale score (IDS). An expert anesthesiologist did laryngoscopy and intubation, and difficult cases were recorded. Results: Our study showed that the frequency of difficult intubation with IDS > 4 was %16, and with IDS > 5 was %3. The variables, including age, weight, height, and SMD, significantly predicted difficult intubation. The cut-off points for age < 6 months, weight < 5/9 kg, height < 61 cm, and SMD < 5/3 cm were obtained, respectively. Other variables, such as MO, AASI, NC, and sex, were unreliable predictors for difficult intubation. Conclusions: We found that IDS > 4, age< 6-month, weight < 5/9 kg, and SMD < 5/3 cm are predictors for difficult intubation. It is helpful for the anesthesiologist to measure these predictions before anesthesia is started to find who has difficult intubation.

scholarly journals 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 ◽  
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.

scholarly journals Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients

2016 ◽  
Vol 1 (2) ◽  
pp. 41-44
Author(s):  
Johann Mathew
Keyword(s):  
Tracheal Intubation ◽  
Difficult Intubation ◽  
Mouth Opening ◽  
Difficult Tracheal Intubation ◽  
Neck Circumference ◽  
Obese Patients ◽  
Chi Square ◽  
Neck Extension ◽  
Difficulty Scale ◽  
Nonobese Patients

ABSTRACT Background Anticipating a difficult airway is of prime importance to an anesthesiologist. Data available are inconclusive to say that tracheal intubation is more difficult in the obese. The deficiency occurring with individual factors can be avoided by adopting multiple airway assessment factors. In this study, we aim to compare the incidence of difficult intubation between obese and nonobese patients and compare three predictors of difficult intubation. Study design Prospective observational study. Materials and methods About 250 patients were assigned to two groups, obese and nonobese based on their body mass index. Preoperatively, neck circumference (NC), mouth opening, thyromental distance (TMD), neck extension, NC/TM ratio, Mallampati classification (MPC), and Wilson score (WS) were calculated. Difficulty of intubation was assessed using the intubation difficulty scale (IDS). All tracheal intubations were performed by anesthetists with more than 2 years of experience. Statistical analysis used Data analysis was done with the help of Statistical Package for the Social Sciences (SPSS) version 15, MedCalc version 11, and Epi data software. Qualitative data are presented with the help of frequency and percentage table, and association among various study parameters is done with chi-square test. Results The incidence of difficult intubation determined by the IDS (≥5) was more frequent in the obese group (88.6% in obese vs 11.4% in nonobese). Of the three variables, WS was found to be statistically significant (p < 0.005). Neck circumference to thyromental ratio is a new predictor for difficult tracheal intubation (DTI). But an NC/TM ratio of ≥5 gives high false positive for our population. How to cite this article Mathew J, Gvalani SK. Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients. Res Inno in Anesth 2016;1(2):41-44.

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

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.

scholarly journals Comparison of Upper Lip Bite Test with Modified Mallampati Score in Predicting Difficult Intubation

2022 ◽  
Vol 7 (1) ◽  
pp. 1-8
Author(s):  
Monish Thomas ◽  
Nichelle M. Saldanha
Keyword(s):  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Anaesthetic Management ◽  
Class Iii ◽  
Upper Lip ◽  
Intubation Difficulty ◽  
Mallampati Score ◽  
Difficulty Scale ◽  
A Prospective Study

Background and Aims: Identifying a patient with a difficult airway is important in planning anaesthetic management so that endotracheal intubation can be achieved safely. This study aims to compare modified Mallampati score with Upper Lip Bite Test to predict difficult intubation using intubation difficulty scale. Materials and methods: A prospective study was carried on 104 patients, both sexes aged between 18 to 60 years scheduled for elective surgeries under general anaesthesia fulfilling inclusion and exclusion criteria. Patient airway was evaluated by MMT and ULBT preoperatively. Predictors of difficult endotracheal intubation were assigned to MMT class III and IV, ULBT class III. After premedication and induction laryngoscopy was performed. After successful intubation Intubation difficulty score was noted down based on the sum of seven assessing parameters. A score >5 was considered difficult intubation. Results: The incidence of difficult intubation in the study was 10.6% (i.e. 11 out of 104 patients). In this study ULBT had a higher sensitivity (90.9% v/s 18.20%), specificity (95.7% v/s 75.3%) PPV (71.4% v/s 8%) and NPV (98.9% v/s 88.6%) than that of MMT Conclusion: Upper lip bite test is better at predicting difficult intubation with higher accuracy when compared to Modified Mallampati test. Both the tests are good predictors of easy intubation. Keywords: Upper Lip Bite Test (ULBT), Modified Mallampati test (MMT), Intubation Difficulty scale (IDS), airway assessment. Difficult intubation prediction, Difficult airway

scholarly journals Relationship of neck circumference and difficult endotracheal intubation in obese patients

2017 ◽  
Vol 4 (2) ◽  
pp. 3-9
Author(s):  
Amit Kumar Karna ◽  
Khalid Bashir
Keyword(s):  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Pearson Correlation ◽  
Anesthetic Management ◽  
Cricoid Cartilage ◽  
Neck Circumference ◽  
Obese Patients ◽  
Patient Identification ◽  
Intubation Difficulty ◽  
Difficulty Scale

Background and Objectives: Patient identification with difficult intubation is important in planning anesthetic management and one major factor for difficult intubation in t he obese patients is large neck circumference. The need for prediction of a potentially difficult airway received great importance as it plays a significant role in reducing morbidity and mortality. Therefore, this study was done to glimpse the effect of neck circumference on endotracheal intubation and to determine the frequency of difficult intubation.Material and Methods: The study was cross sectional descriptive study and convenient sampling technique was used. Seventy patients of age between 19-50 years of both sexes were enrolled. Neck circumference was measured at the level of cricoid cartilage along with other airway assessments. Direct laryngoscopy was done and checked whether it is difficult one or easy using Intubation difficulty scale. Data were entered and analyzed by using statistical software SPSS version 15.0. Results: Mean BMI was noted as 33.02±2.30 kg/m2 and the mean neck circumference was 43.64±2.30 cm. Difficult intubation was observed in 23 (32.86%) patients with mean neck circumference of 45.44±1.88 cm and normal intubation observed in 47(67.14%) patients with mean neck circumference of 42.77±1.98 cm. Linear correlation was found between the neck circumference and Intubation Difficulty Scale score with value of Pearson correlation=0.617 .Conclusion: Neck circumference of patient was found to have significant effects on difficult intubation. Frequency of difficult intubation was found in almost one third of obese patients with increasing neck circumference.Janaki Medical College Journal of Medical Sciences (2016) Vol. 4 (2): 3-9 

scholarly journals Comparison of sniffing position and simple head extension for visualization of glottis during direct laryngoscopy.

2012 ◽  
Vol 9 (1) ◽  
pp. 58-63 ◽  
Author(s):  
B Bhattarai ◽  
S K Shrestha ◽  
S Kandel
Keyword(s):  
Tracheal Intubation ◽  
Direct Laryngoscopy ◽  
Elective Surgery ◽  
Demographic Profiles ◽  
Intubation Difficulty ◽  
Ideal Position ◽  
Head Extension ◽  
Extension Group ◽  
Difficulty Scale ◽  
Difficulty Score

Background The ability of good glottis visualization during direct laryngoscopy is major determinant of easy tracheal intubation. Sniffing position for laryngoscopy is considered as gold standard and ideal position. Several studies have questioned the validation of sniffing potion. Objectives This study aims to compare relative efficacy of sniffing position and simple head extension for visualization of glottis during direct laryngoscopy. Methods Four hundred patients undergoing elective surgery under general anesthesia requiring endotracheal intubation were randomized into two groups and study was concluded. Glottic visualization was assessed using modified Cormack and Lehane classification. After laryngoscopy, tracheal intubation was performed and intubation difficulty scale was noted. Results Both the groups were comparable regarding glottis visualization. Both the groups were comparable in demographic profiles. All the intubation difficulty scale variables were comparable in both the groups except N3. Total Intubation Difficulty Score was better in sniffing position than in simple head extension group. Conclusion Glottic visualization and intubation difficulty score was better in sniffing position as compared to simple head extension.http://dx.doi.org/10.3126/kumj.v9i1.6265 Kathmandu Univ Med J 2011;9(1):58-63

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

2012 ◽  
Vol 63 (6) ◽  
pp. 491 ◽  
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

The Intubation Difficulty Scale (IDS) 

1997 ◽  
Vol 87 (6) ◽  
pp. 1290-1297 ◽  
Author(s):  
Frederic Adnet ◽  
Stephen W. Borron ◽  
Stephane X. Racine ◽  
Jean-Luc Clemessy ◽  
Jean-Luc Fournier ◽  
...  
Keyword(s):  
Operating Room ◽  
Predictive Factors ◽  
Difficult Intubation ◽  
Analog Scale ◽  
Independent Observer ◽  
Intubation Difficulty ◽  
Time To Completion ◽  
Quantitative Score ◽  
Difficulty Scale ◽  
Categorical Classification

Background A quantitative scale of intubation difficulty would be useful for objectively comparing the complexity of endotracheal intubations. The authors have developed a quantitative score that can be used to evaluate intubating conditions and techniques with the aim of determining the relative values of predictive factors of intubation difficulty and of the techniques used to decrease such difficulties. Methods An Intubation Difficulty Scale (IDS) was developed, based on parameters known to be associated with difficult intubation. It was then evaluated prospectively in a group of 311 consecutive prehospital intubations and 315 intubations in an operating room. In the operating room, the IDS was compared with two other parameters: the time to completion of intubation and the visual analog scale (VAS). Time was measured by an independent observer. Operators in both groups completed a checklist regarding the conditions of intubation. Results There is a good correlation between the IDS scale and the VAS assessment of difficulty and time to completion of intubation. VAS and time to completion have a significant but lesser correlation to each other. Comparison of IDS with operator-assessed subjective categorical impression of difficulty by Kruskall-Wallis was statistically significant. Conclusions The IDS correlates with but is less subjective than the VAS and categorical classification. IDS correlates with time to intubation, but it offers details regarding the difficulty encountered that time alone does not. This score may not only aid in evaluation of factors linked to difficult intubations, but it may provide a uniform approach to comparing studies related to this subject.

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