Identification of Ideal Preoperative Predictors for Difficult Intubation

Authors

  •   Ruchi Garg Departments of Anesthesiology and Critical Care, Ram Manohar Lohia Hospital, New Delhi
  •   C. K. Dua Santosh Medical College, Ghaziabad, Uttar Pradesh

Keywords:

Airway predictors, difficult intubation, intubation difficulty scale

Abstract

Background: Unexpected difficult intubation is probably the result of inadequate preoperative examination of airway and a lack of accurate predictive tests for difficult intubation. Preoperative evaluation forms basis to suspect and be prepared for a difficult airway situation. Aim: The aim of our study was to identify the ideal preoperative predictors of difficult intubation. Materials and Methods: It was a Prospective Observational study done on 350 patients in a community-based hospital. Preoperative airway assessment included: Mallampati Class (MC), Mouth opening (MO), Thyromental distance (TMD), Ability to prognath (AP) and Neck mobility and size (NM). Monitors were attached, anesthesia induced and laryngoscopy performed. Intubation Difficulty Scale (IDS) score was used to grade difficulty in intubation. Results: The overall incidence of Difficult Intubation was 24.6 %. A slight difficulty in 24% (IDS = 1-5) and moderate to major difficulty (IDS >5) in 0.6% cases was noted. Intubation was possible in all the patients. Mallampati class III & Mouth opening was less than 4 cm in about 6% cases and Thyromental distance less than 6 cm in 5.4%. 12.5% were unable to prognath and Neck mobility was restricted in 4.6% patients. Sensitivity and specificity of MC- 16.3 % and 97%, MO- 16.3% and 96.6%, TMD - 12.8% and 97%, AP - 33.3% and 93.9% , NM - 10.5% and 97.3%. Positive and Negative Predictive Values for MC, MO, TMD, AP and NM were 63.6% and 78%, 60.9% and 78%, 57.9 and 77.3 %, 62.8% and 81.9%, 56.3% and 76.9% respectively. Conclusion: We concluded that Mallampati grading and ability to prognath are the most important of the variables studied

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Published

2015-09-01

How to Cite

Garg, R., & Dua, C. K. (2015). Identification of Ideal Preoperative Predictors for Difficult Intubation. Karnataka Anaesthesia Journal, 1(4), 174–180. Retrieved from http://karnatakaanesthesiajournal.in/index.php/kaj/article/view/139414

Issue

Volume 1, Issue 4, October - December 2015

Section

Original Articles

References

Rose DK, Cohen MM. The airway: Problems and predictions in 18,500 patients. Can J Anaesth 1994;41:372‑83.

Arné J, Descoins P, Fusciardi J, Ingrand P, Ferrier B, Boudigues D, et al. Preoperative assessment for difficult intubation in general and ENT surgery: Predictive value of a clinical multivariate risk index. Br J Anaesth 1998;80:140‑6.

Türkan S, Ateş Y, Cuhruk H, Tekdemir I. Should we reevaluate the variables for predicting the difficult airway in anesthesiology? Anesth Analg 2002;94:1340‑4, table of contents.

Tse JC, Rimm EB, Hussain A. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: A prospective blind study. Anesth Analg 1995;81:254‑8.

Practice guidelines for management of the difficult airway. A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 1993;78:597‑602.

Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, et al. A clinical sign to predict difficult tracheal intubation: A prospective study. Can Anaesth Soc J 1985;32:429‑34.

Oates JD, Macleod AD, Oates PD, Pearsall FJ, Howie JC, Murray GD.Comparison of two methods for predicting difficult intubation. Br J Anaesth 1991;66:305‑9.

Samsoon GL, Young JR. Difficult tracheal intubation: A retrospective study. Anaesthesia 1987;42:487‑90.

Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth 1988;61:211‑6.

Aiello G, Metcalf I. Anaesthetic implications of temporomandibular joint disease. Can J Anaesth 1992;39:610‑6.

Wilson WC, Benumof JL. Pathophysiology, evaluation, and treatment of the difficult airway. Anesthesiol Clin North America 1998;16:41‑3.

Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics.Anaesthesia 1984;39:1105‑11.

Adnet F, Borron SW, Racine SX, Clemessy J, Fournier, Plaisance P, et al. The Intubation Difficulty Scale (IDS): Proposal and evaluation of a new score characterizing the complexity of endotracheal intubation.

Anesthesiology 1997;87:1290‑7.

Crosby ET, Cooper RM, Douglas MJ, Doyle DJ, Hung OR, Labrecque P, et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth 1998;45:757‑76.

Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: A meta‑analysis of bedside screening test performance. Anesthesiology 2005;103:429‑37.

Merah NA, Wong DT, Ffoulkes‑Crabbe DJ, Kushimo OT, Bode CO.Modified Mallampati test, thyromental distance and inter‑incisor gap are the best predictors of difficult laryngoscopy in West Africans. Can J Anaesth 2005;52:291‑6.

el‑Ganzouri AR, McCarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative airway assessment: Predictive value of a multivariate risk index. Anesth Analg 1996;82:1197‑204.

Tham EJ, Gildersleve CD, Sanders LD, Mapleson WW, Vaughan RS. Effects of posture, phonation and observer on mallampati classification. Br J Anaesth 1992;68:32‑8.