Difficult Intubation Clinical Trial
Official title:
Evaluation of the Effectiveness of Simplified Predictive Intubation Difficulty Score in Difficult Airway
Difficult intubation is considered one of the most important obstacle increasing mortality in
anesthesiology. Airway assessment tests are proceeded to overcome these difficulties in the
pre-anesthetic evaluation. In this study, the Simplified Predictive Intubation Difficulty
Score (SPIDS) and Thyromental Height Measurement (TMH) were chosen as primary methods to
predict difficult intubation. The ear-nose-throat (ENT) and Plastic Surgery patients were
planned to enroll this study to assess the effectiveness of these tests in predicting
difficult intubation in Maltepe University Hospital and Sisli Hamidiye Etfal Governmental
Hospital.
The SPIDS of volunteers will be calculated according to their previous knowledge of difficult
intubation, airway pathologies, head and neck movements, mouth opening, modified Mallampati
test and thyromental distance. TMH value will be measured with ASIMETO depth device. Finally,
the SPIDS and TMH values will be statistically compared to predict difficult intubation which
is determined with difficult intubation score (IDS).
The investigators would like to evaluate consecutively patients, who applied to be operated
in plastic surgery and ENT clinics due to head and neck pathologies which may cause difficult
intubation, between May 2016 and December 2017 . The patients will be recruited to study
consecutively therefore, there is going to be no randomization. The patients' height, age,
weight, American Society of Anesthesiology (ASA) scores will be documented. Additionally,
their Mallampati scores, thyromental distance, thyromental height, mouth opening values will
be measured with ASIMETO DEPTH GAUGE digitally. Head and neck movement angle measurement will
proceed in preoperative evaluation. In the operation room the intubation, determination of
C-L and IDS are going to be operated by the anesthesiologist who is in charge of operating
room and he or she will not be informed about airway assessments like SPIDS or TMH. The all
difficult airway equipment will be readily prepared in advanced. Recorded data will be
collected by the assistant researcher. The existing difficult intubation interventions will
be determined by using IDS. The relationship between IDS, TMH and SPIDS values will be
assessed in the means of predicting difficult airway.
Measurements:
Mallampati score: It has four grades and Mallampati 3 and 4 considered predictive factor for
difficult intubation Thyromental distance (TMD): Short thyromental distance (TMD ≤ 6.5 cm)
has been correlated with difficult direct laryngoscopic intubation in adult patients.
Thyromental height (TMH): This is a new technique for predicting difficult intubation and its
accepted cut off is generally 5cm.
Height/Thyromental distance: Ratio of height in cm and thyromental distance in cm Intubation
difficulty score (IDS): 0 is easy, 0-5 is slight difficulty and higher than 5 is moderate or
serious difficulty in intubation.
The simplified descriptive intubation difficulty score (SPIDS): The maximum score can be 55
and the total score greater than 10,not SPIDS ≤ 10 is considered as difficult intubation.
Calculation of SPIDS score following parameters is needed.
1. History of pathologies might be related to difficult intubation such as obstructive
sleep apnea, facial malformations, cervical dislocation etc. no is 0, yes 10 is points
2. Mouth opening: ≥3.5 cm (0 points)- ≤3.5 cm (10 points)
3. Maximum head and neck measurement ≥80°(0 points), <80 (5 points)
4. Modified Mallampati test: class 1 (0 point ), class 2 (10 points), class 3 (15 points),
class 4 (25 points)
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