Comparison of Four Methods for Predicting Difficult Laryngoscopy: A Prospective Study of Validity Indexes
-
Farhad Etezadi
,
Leila Saeedinia
,
Pejman Pourfakhr
,
Atabak Najafi
,
Mohammadreza Khajavi
,
Aylar Ahangari
,
Reza Shariat Moharari
Abstract
Background: Considering that a simple yet valid airway predictor is basically preferred to a multivariable test with the same level of validity, we designed a study to compare the validity indexes of the TMHT, as a single variable test, with that of Wilson, Arne, and Naguib tests.
Methods: 270 consecutive ASA physical statues I and II patients aged ≥16 years, candidate to receive general anesthesia for elective surgeries, were enrolled in the study. All patients preoperatively were evaluated using four airway predictor tests including Wilson, Arne, Naguib, and Thyromental height test (TMHT). Cut-off points to predict a difficult laryngoscopy were extracted from previous published studies for each test. Based on each predictor, all patients were classified into either easy or difficult. Based on Cormack-lehane scoring system, as the gold standard, all patients during laryngoscopy were categorized into two groups of “easy, grades I, II” and “difficult, grades III, IV”. Finally, validity indexes for each test were calculated and compared to one another.
Results: The incidence of difficult laryngoscopy according to Cormack-lehane grading was 17.4% (47/270). The predicted rates of difficult laryngoscopy were 47 (17.4%), 2 (0.7%), 10 (3.7%) and 61 (22.6%) for TMHT, Wilson, Arne and Naguib respectively. Based on Chi-square test, the TMHT as well as the Naguib could significantly predict difficult laryngoscopy. However, the highest rate of sensitivity, positive predictive value, negative predictive value, and accuracy belonged to TMHT.
Conclusion: Both TMHT and Naguib are acceptable predictors of difficult laryngoscopy while the TMHT is a more accurate predictor of difficult laryngoscopy than the other multivariable models.
Naguib M, Scamman FL, O'Sullivan C, Aker J, Ross AF, Kosmach S, et al. Predictive Performance of Three Multivariate Difficult Tracheal Intubation Models: A Double-Blind, Case-Controlled Study. Anesth Analg. 2006; 102(3):818-24.
King TA, Adams AP. Failed tracheal intubation. Br J naesth.1990; 65(3):400-14.
National Collaborating Centre for Women's and Children's Health (UK). Pregnancy and Complex Social Factors: A Model for Service Provision for Pregnant Women with Complex Social Factors. London: RCOG Press; 2010 Sep. (NICE Clinical Guidelines, No.110.) References Available from: http://www.ncbi.nlm.nih.gov/books/NBK62619/
Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth. 1988; 61(2): 211-6.
Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987; 42(5): 487-90.
Benumof JL. Management of the difficult adult airway: with special emphasis on awake tracheal intubation. Anesthesiology. 1991; 75:1087–110
Ise JC, Rimm EB, Hussain A. Predicting Difficult Endotracheal Intubation in Surgical Patients Scheduled for General Anesthesia: A Prospective Blind Study. Anesth Analg. 1995;81(2):254-8.
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(2):140-6
Naguib M, Malabarey T, AlSatli RA, Al Damegh S, Samarkandi AH. Predictive models for difficult laryngoscopy and intubation: a clinical, radiologic and three-dimensional computer imaging study. Can J Anaesth. 1999; 46(8): 748-59
Etezadi F, Ahangari A, Shokri H, Najafi A, Khajavi MR, Daghigh M, et al. Thyromental height: a new clinical test for prediction of difficult laryngoscopy. Anesth Analg. 2013;117(6):1347-51.
Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984; 39(11): 1105-11.
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(6):1197-204.
Merah NA, Wong DT, Foulkes-Crabbe DJ, Kushimo OT, Bode CO. Modified Mallampati test, thyromental distance and interincisor gap are the best predictors of difficult laryngoscopy in West Africans. Can J Anaesth. 2005; 52(3):291–6
Krobbuaban B, Diregpoke S, Kumkeaw S, Tanomsat M. The predictive value of the height ratio and thyromental distance: four predictive tests for difficult laryngoscopy. Anesth Analg. 2005; 101(5):1542–5
Khan ZH, Mohammadi M, Rasouli MR, Farrokhnia F, Khan RH. The diagnostic value of the upper lip bite test combined with sternomental distance, thyromental distance, and interincisor distance for prediction of easy laryngoscopy and intubation: a prospective study. Anesth Analg. 2009; 109(3): 822–4.
Knill RL. Difficult laryngoscopy made easy with a “BURP”. Can J Anaesth. 1993; 40(3):279-82.
Takahata O, Kubota M, Mamiya K, Akama Y, Nozaka T, Matsumoto H, et al. The efficacy of the “BURP” maneuver during a difficult laryngoscopy. Anesth Analg. 1997; 84(2): 419–21
Ulrich B, Listyo R, Gerig HJ, Gabi K, Kreienbühl G. The difficult intubation. The value of BURP and 3 predictive tests of difficult intubation. Anaesthesist. 1998; 47(1):45-50.
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(2): 429–37.
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| Issue | Vol 4 No 3 (2018): Summer |
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| Section | Research Article(s) | |
| Keywords | ||
| difficult laryngoscopy airway assessment airway predictor test cormack-lehane grading | ||
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