scholarly journals Thyromental Height - As a Predictor of Difficult Laryngoscopy

2021 ◽  
pp. 223-231
Author(s):  
Harivarshan Velusamy Gothandaramalingam ◽  
Muralidharan Vittobaraju
Keyword(s):  
Difficult Airway ◽  
Difficult Intubation ◽  
Preoperative Assessment ◽  
High Sensitivity ◽  
Difficult Laryngoscopy ◽  
Screening Tests ◽  
P Value ◽  
Elective Surgical Procedures ◽  
High Negative Predictive Value ◽  
Diverse Patient Population

The fundamental responsibility of the anaesthesiologist and one of the most important steps in anaesthesia practice is the intubation and maintenance of the airway. The integral part of pre-anaesthetic evaluation to recognize a potentially difficult airway is the airway assessment. There are multitude of bedside screening tests which are helpful to predict a difficult airway but the accuracy is doubtful. Thus, pointing out a single reliable predictor of difficult intubation is important. Accordingly, this study aims to evaluate the practicality of thyromental height test alone as a sole predictor of difficult laryngoscopy in our present population. Ethical clearance was obtained and after taking an informed consent, a randomised prospective observational study was conducted on 315 adult patients who were posted for elective surgical procedures under general anaesthesia with endotracheal intubation. On the day before the surgery, airway was assessed and Thyromental height (TMHT) was measured. Laryngoscopy was performed intra-operatively and Cormack Lehane’s grading was noted. The evaluation of the accuracy of thyromental height in predicting difficult laryngoscopy was done by comparing the preoperative assessment data and laryngoscopy findings. In our study, the mean thyromental height observed was 5.4cm. Thyromental height at cut off of 50mm had a high negative predictive value of 94.1% and high sensitivity of 72.5%, but with low specificity of 64.2% (P value 0.000). When the cut off was emended to 48mm, sensitivity of the test decreased to 56.2% and specificity increased to 79.8% (P value 0.002).The conducted study demonstrates the usefulness of thyromental height. It substantiates the good sensitivity of thyromental height for predicting difficult intubation. But, the validation will require further studies in more diverse patient population. 

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.

PREOPERATIVE ASSESSMENT OF VARIABLES TO PREDICT DIFFICULT INTUBATION IN PATIENTS UNDERGOING SURGERIES UNDER GENERAL ANAESTHESIA

2021 ◽  
pp. 68-71
Author(s):  
Veena Chatrath ◽  
Leena Mahajan ◽  
Gagandeep Kaur ◽  
Ankita Taneja ◽  
Ranjana Khetarpal ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Risk Index ◽  
Preoperative Assessment ◽  
High Sensitivity ◽  
Screening Tests ◽  
Failed Intubation ◽  
Upper Lip ◽  
Number Of Patients

Background- Advance prediction of difcult airway provides us ample time for optimal preparation of equipment and participation of experienced anaesthesiologist to handle difcult airway. The present study was designed to evaluate the efcacy of Upper Lip Bite Test (ULBT), Ratio of neck circumference (NC) and thyromental distance (TMD) and Arne Risk Index in predicting difcult airway. Material and methods-This prospective observational study was conducted on 250 patients, aged 18-60 years of ASAgrade I and II scheduled for surgeries under general anaesthesia. Three screening tests i.e. ULBT, NC/TMD and Arne Risk Index were used to predict difcult airway. Number of patients successfully intubated, number of attempts taken for intubation and time taken for intubation was noted. Difcult intubation was calculated using Intubation Difculty Score (IDS). All the three screening tests were compared for their sensitivity, specicity, negative predictive value (NPV) and Positive predictive value (PPV) to predict difcult airway. Result- The incidence of difcult intubation was found to be 6.8%. 233 (95.2%) patients were intubated in rst attempt and 12 (4.8%) patients were intubated in second attempt and there was no failed intubation. Arne Risk Index had high sensitivity (88.23%), high specicity (88.84%), highest NPV (99.04%) and PPV of 36.58%. ULBThas sensitivity of 76.47%, specicity of 88.41%, NPV of 98.09% and PPV of 32.50% and NC/TMD has sensitivity of 47.05%, specicity of 87.98%, PPVof 22.22% and NPVof 95.79% in predicting difcult airway. Conclusion- Arne Risk index, a multivariate clinical risk index had highest sensitivity, specicity, NPVand PPVto predict difcult airway.

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.

scholarly journals Magnitude and Predisposing Factors of Difficult Airway during Induction of General Anaesthesia

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Sileshi Abiy Workeneh ◽  
Amare Hailekiros Gebregzi ◽  
Zewditu Abdissa Denu
Keyword(s):  
Difficult Airway ◽  
General Anaesthesia ◽  
Difficult Intubation ◽  
Mouth Opening ◽  
Predisposing Factors ◽  
Difficult Laryngoscopy ◽  
Failed Intubation ◽  
Predisposing Factor ◽  
Specific Test ◽  
Cross Sectional

Objective. To assess magnitude and predisposing factors of difficult airway during induction of general anaesthesia. Methods. Hospital based cross sectional study carried out to determine the incidence of difficult mask ventilation, difficult laryngoscopy (Cormack and Lehane III and IV), difficult intubation (IDS ≥ 5), and failed intubation. The association between each predisposing factor and airway parameters with components of difficult airway is investigated with binary logistic regression. Sensitivity, specificity, positive and negative predictive value of the test, and odds ratio with 95% confidence interval were calculated to determine the association between independent and dependent variable. Result. The incidence of difficult laryngoscopy, difficult intubation, and failed intubation are 12.3%, 9%, and 0.005%, respectively. Mouth opening < 30 mm and Mallampati classes III and IV are the most sensitive tests and second high specific test next to combination of tests to predict difficult intubation and laryngoscopy (P value < 0.001). Unrestricted multiple attempt without alternative airway techniques resulted in exponential increase in desaturation episodes and further difficulty of airway management (P value < 0.001). Discussion and Conclusion. Mallampati classes III and IV, mouth opening ≤ 30 mm, jaw slide grade C, attempt > 3, and ineffective alternative technique have increased predictability value of difficult airway.

scholarly journals Assessment of Airway Parameters for Predicting Difficult Laryngoscopy and Intubation in a Tertiary Center in Western Nepal

2020 ◽  
Vol 17 (4) ◽  
pp. 516-520
Author(s):  
Gajal Lakhe ◽  
Hari Poudel ◽  
Krishna Murari Adhikari
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Difficult Intubation ◽  
Predictive Value ◽  
Area Under Curve ◽  
Difficult Laryngoscopy ◽  
Screening Tests ◽  
Upper Lip ◽  
Tertiary Center ◽  
Lehane Grade

Background: The screening tests used for pre-operative evaluation of airway to predict difficult laryngoscopy and intubation have variable diagnostic accuracy. The unanticipated poor laryngeal view is gold standard for defining difficult intubation. We aimed to find out the prevalence of difficult laryngoscopy and intubation, which airway parameter better predicts difficult intubation and whether difficult laryngoscopy is associated with difficult intubation or not.Methods: This analytic cross sectional study was conducted in 665 ASA I/II adult patients, aged 18-65, without obvious airway pathology undergoing elective surgery under general anesthesia. The pre-operative screening tests included mouth opening, modified mallampatti, ratio of height to thyromental distance, sternomentaldistance and upper lip bite test. Cormack-Lehane grade III/ IV was defined as difficult laryngoscopy and potentially difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under curve at 95% confidence interval was calculated for all five screening tests. Results: The prevalence of difficult laryngoscopy and intubation was 6.6% (44 cases). The upper lip bite test because of its highest specificity, positive predictive value, negative predictive value, accuracy and area under curve (99.7%; 93.9%; 99.7%; 95.2%; 85.1% respectively) with moderate level of sensitivity (70.5%) was better predictor of difficult intubation than other tests. The difficult laryngoscopy was associated with difficult intubation (p=0.00).Conclusions: The prevalence of difficult laryngoscopy and intubation was 6.6%.The upper lip bite test was a better predictor of difficult intubation and there was a significant association of difficult laryngoscopy with difficult intubation.Keywords: Difficult laryngoscopy and intubation; screening tests; upper lip bite test.

D-Dimers, Thrombin Antithrombin III Complexes and Prothrombin Fragments 1 + 2: Diagnostic value in Clinically Suspected Deep Vein Thrombosis

1991 ◽  
Vol 65 (01) ◽  
pp. 028-032 ◽  
Author(s):  
B Boneu ◽  
G Bes ◽  
H Pelzer ◽  
P Sié ◽  
H Boccalon
Keyword(s):  
Deep Vein Thrombosis ◽  
Antithrombin Iii ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Predictive Values ◽  
Vein Thrombosis ◽  
High Negative Predictive Value ◽  
Deep Vein ◽  
D Dimer ◽  
Mercury Strain Gauge

SummaryThis study was performed to determine the accuracy of D-Dimer fibrin derivatives, thrombin-antithrombin III (TAT) complexes and prothrombin fragments 1 + 2 (F 1 + 2) determinations for the diagnosis of deep vein thrombosis (DVT). One hundred and sixteen consecutive patients referred to the angiology unit of our hospital for a clinically suspected DVT were investigated. They were submitted to mercury strain gauge plethysmography and to ultrasonic duplex scanning examination; in cases of inconclusive results or of proximal DVT (n = 35), an ascending phlebography was performed. After these investigations were completed, the diagnosis of DVT was confirmed in 34 and excluded in 82. One half of the patients were already under anticoagulant therapy at the time of investigation. The 3 biological markers were assayed using commercially available ELISA techniques and the D-Dimer was also assayed with a fast latex method. The normal distribution of these markers was established in 40 healthy blood donors. The most accurate assay for the diagnosis of DVT was the D-Dimer ELISA which had both a high sensitivity (94%) and a high negative predictive value (95%). The D-Dirner latex, TAT complexes and F 1 + 2 were far less sensitive and provided negative predictive values which ranged between 78 and 85%. In spite of positive and significant correlations between the levels of ihe 3 markers, their association did not improve their overall accuracy for detecting D\/L Therefore, with the exception of the D-Dimer ELISA, these markers were of little value for the diagnosis of DVT in this specific population.

scholarly journals Adding stress biomarkers to high sensitivity troponin measurements increases precision and efficacy of rapid rule out protocols for NSTEMI

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Restan ◽  
O.T Steiro ◽  
H.L Tjora ◽  
J Langoergen ◽  
T Omland ◽  
...  
Keyword(s):  
Chest Pain ◽  
Acute Chest Pain ◽  
High Sensitivity ◽  
Final Diagnosis ◽  
Public Institution ◽  
P Value ◽  
Funding Source ◽  
University Hospitals ◽  
High Sensitivity Troponin ◽  
Rule Out

Abstract Background NSTEMI may be ruled out in patients presenting with acute chest pain based on low baseline high sensitivity troponin (cTn) at admission. This procedure is limited by a low expected frequency of ruled out non-cardiac chest pain (NCCP) patients. Purpose To investigate if stress-induced biomarkers (glucose or copeptin) combined with cTn can increase the rate of NCCP ruled out without an unacceptable increase in incorrectly ruled out NSTEMI. Method 971 patients with suspected NSTE-ACS were included. Final diagnosis was adjudicated by two independent cardiologists using clinical data including routine cTnT. Additionally, baseline cTnI, cTnI from Singulex Clarity System (cTnI(sgx)), copeptin and glucose were measured. Diagnostic performance to rule out NSTEMI was compared between the ESC rule out algorithms for cTnT and cTnI(Abbott), a local cTnI(sgx) algorithm and different combinations of cTn with copeptin or glucose Results Median age 61 years, 60% male. 13% had NSTEMI, 12% had UAP and 60% NCCP. Distribution of copeptin and glucose concentrations (NSTEMI and NCCP) is shown in figure 1. Copeptin and cTnT produces an algorithm with lower miss rate for NSTEMI, increased rule out rate for NCCP and significantly higher AUC (DeLong test, p value &lt;0.001) compared to the ESC algorithm (Table 1). cTnI(sgx) and copeptin showed higher rule out for NCCP and higher AUC (p value &lt;0.001), however an increased rule out rate for NSTEMIs. Combining cTnI(Abbott) and glucose gave a similar miss rate for NSTEMI as ESC, but increased rule out rate for NCCP and higher AUC (p value &lt;0.001). Conclusion Combining cTnT or cTnI(sgx) with copeptin; or cTnI with glucose, improves diagnostic precision and efficacy of rule out protocols for NSTEMI in patients presenting with acute chest pain. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Western Norway Regional Health Authority; Haukeland and Stavanger University Hospitals

scholarly journals Application of high-flow nasal oxygenation as a rescue therapy in difficult videolaryngoscopic intubation

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110100
Author(s):  
Min Ho Lee ◽  
Hyun Joo Kim
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Rescue Therapy ◽  
High Flow ◽  
Mask Ventilation ◽  
Induction Process ◽  
Management Method ◽  
Adequate Oxygenation

In difficult airway situations, the next step of the airway management method is selected according to the prior presence of difficulties in mask ventilation and endotracheal intubation. It is important for the practitioner to be calm, quick in judgment, and take action in cases of difficult intubation. Recently, high-flow nasal oxygenation has been rapidly introduced into the anesthesiology field. This technique could extend the safe apnea time to desaturation. Especially, it maintains adequate oxygenation even in apnea and allows time for intubation or alternative airway management. We report two cases in which high-flow nasal oxygenation was implemented in the middle of the induction process after quick judgment by clinicians. High-flow nasal oxygenation was successfully used to assist in prolonging the safe apnea time during delicate airway securing attempts.

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