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.
Difficult airway assessment is based on various anatomic parameters of upper airway, much of
it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of
tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this study
.
The sample consisted of adult patients scheduled to receive general anaesthesia. Anatomic
features of the neck were measured pre-operatively.
The anatomic features of the neck measured were 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. The commonly used predictive tests head extension, mouth opening, upper lip
bite test and Mallampati class were also measured.
The laryngoscopic view was classified according to the Cormack-Lehane Grade (1-4). Difficult
laryngoscopy was defined as Cormack-Lehane Grade 3 or 4. Years of experience of the
anaesthesiologists were recorded, as well as the number of tries needed to intubate the
patient.
The optimal cut-off points for each predictive tests were identified by using receiver
operating characteristic analysis. Sensitivity, specificity and positive predictive value
and negative predictive value (NPV) were calculated for each test. Multivariate analysis
with logistic regression, including all variables, was used to create a predictive model.
Comparisons between genders were also performed to explore possible differences in
diagnostic value and cut-off points. Finally, the years of experience of the clinician and
the number of tries needed to intubate the patient were compared to assess risk of bias.
;
Observational Model: Cohort, Time Perspective: Prospective
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