Airway Management Clinical Trial
Official title:
Anatomic Features of the Neck and Preoperative Tests as Predictive Markers of Difficult Direct Laryngoscopy
In this prospective, open cohort study the diagnostic value of tests based on neck anatomy
in predicting difficult laryngoscopy was assessed.
The anatomic features of the neck measured were head extension, mouth opening, upper lip
bite, Mallampati class, thyromental distance, sternomental distance, ratio of height to
thyromental, neck circumference, thyrosternal distance, hyomental distance at full head
extension (FHE) and at neutral position (NP), ratio of neck circumference to thyromental
distance and ratio of hyomental distance FHE to hyomental distance NP.
Status | Completed |
Enrollment | 1142 |
Est. completion date | December 2014 |
Est. primary completion date | December 2014 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Adult patients - BMI less than 35 kg/m2 - No known neck or airway pathology - Scheduled for surgical procedures under general anaesthesia with tracheal intubation Exclusion Criteria: - Age less than 18 years - BMI higher than 35 kg/m2 - Obvious airway malformations - Need for rapid sequence induction/intubation under cricoid pressure - Awake intubation - Cervical spine pathology requiring specific manipulation - Obstetric cases |
Observational Model: Cohort, Time Perspective: Prospective
Country | Name | City | State |
---|---|---|---|
n/a |
Lead Sponsor | Collaborator |
---|---|
National and Kapodistrian University of Athens |
Burkle CM, Walsh MT, Harrison BA, Curry TB, Rose SH. Airway management after failure to intubate by direct laryngoscopy: outcomes in a large teaching hospital. Can J Anaesth. 2005 Jun-Jul;52(6):634-40. — View Citation
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Cheney FW. The American Society of Anesthesiologists Closed Claims Project: what have we learned, how has it affected practice, and how will it affect practice in the future? Anesthesiology. 1999 Aug;91(2):552-6. — View Citation
Chipas A, Ellis W, Zaglaniczny K. Airway management. In: Zaglaniczny K, Nagelhout J. Nurse Anesthesia. 3rd edition. USA: Elsevier Saunders; 2004:408
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Crosby ET, Cooper RM, Douglas MJ, Doyle DJ, Hung OR, Labrecque P, Muir H, Murphy MF, Preston RP, Rose DK, Roy L. The unanticipated difficult airway with recommendations for management. Can J Anaesth. 1998 Aug;45(8):757-76. Review. — View Citation
Frova G, Sorbello M. Algorithms for difficult airway management: a review. Minerva Anestesiol. 2009 Apr;75(4):201-9. Review. — View Citation
Greek Society for Airway management, Basic and Advanced Management of the Airway, 2nd edition, Athens, 2011
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Huh J, Shin HY, Kim SH, Yoon TK, Kim DK. Diagnostic predictor of difficult laryngoscopy: the hyomental distance ratio. Anesth Analg. 2009 Feb;108(2):544-8. doi: 10.1213/ane.0b013e31818fc347. — View Citation
Khan ZH, Kashfi A, Ebrahimkhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg. 2003 Feb;96(2):595-9, table of contents. — View Citation
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Rucker JC, Cole D, Guerina LR, Zoran N, Chung F, Friedman Z. A prospective observational evaluation of an anatomically guided, logically formulated airway measure to predict difficult laryngoscopy. Eur J Anaesthesiol. 2012 May;29(5):213-7. doi: 10.1097/EJA.0b013e3283502168. — View Citation
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* Note: There are 22 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Difficult laryngoscopy classification using Cormack-Lehane Grade | Assessment of difficult laryngoscopy at the time of the airway management procedure. Classified as Grade I - visualization of entire laryngeal aperture, grade II - visualization of only posterior commissure of laryngeal aperture, grade III - visualization of only epiglottis, grade IV - visualization of just the soft palate. | immediate | No |
Secondary | Thyromental distance measured in cm with a measuring tape | The distance from the mentum to the thyroid notch while the patient's neck is fully extended and the mouth closed | immediate | No |
Secondary | Sternomental distance measured in cm with a measuring tape | The distance from the suprasternal notch to the mentum while the patient's neck is fully extended and the mouth closed | immediate | No |
Secondary | Ratio of height to thyromental distance | Calculated ratio of the height in cm to the aforementioned thyromental distance | immediate | No |
Secondary | Thyrosternal distance calculated in cm | Calculated from the subtraction: sternomental (cm) minus thyromental (cm) | immediate | No |
Secondary | Neck circumference measured in cm with a measuring tape | Measurement at the level of the cricoid cartilage while the patient's neck is in neutral position | immediate | No |
Secondary | Ratio of neck circumference to thyromental distance | Calculated ratio of the neck circumference to the aforementioned thyromental distance | immediate | No |
Secondary | Hyomental distance at full head extension (FHE) measured in cm with a measuring tape | The distance from the mentum to the hyoid bone while the patient's neck is fully extended and the mouth closed | immediate | No |
Secondary | Hyomental distance at neutral position (NP) measured in cm with a measuring tape | The distance from the mentum to the hyoid bone while the patient's neck is in neutral position and the mouth closed | immediate | No |
Secondary | Ratio of hyomental distance at FHE to hyomental distance at NP | Calculated ratio of the aforementioned variables | immediate | No |
Secondary | Mallampati class | Classified as class I - soft palate, fauces, uvula, and pillars seen, class II - soft palate, fauces, and uvula seen, class III - soft palate and base of uvula seen and class IV - soft palate not visible. | immediate | No |
Secondary | Mouth opening measured in cm with a measuring tape | The distance between the upper and lower incisors with the mouth fully open | immediate | No |
Secondary | Upper lip bite test | Classified as class I - lower incisors can bite the upper lip above the vermilion line, class II - lower incisors can bite the upper lip below the vermilion line and class III - lower incisors cannot bite the upper lip. | immediate | No |
Secondary | Head extension measured in degrees with goniometer | The patient was asked to hold head erect, facing directly to the front, then asked to extend the head maximally and the examiner estimated the angle traversed by the occlusal surface of upper teeth using a goniometer. | immediate | No |
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