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Assessment of laryngeal view: Percentage of glottic opening score vs Cormack and Lehane gradingPurpose: To examine the intra-and inter-rater reliability of two methods that categorize laryngeal view during direct laryngoscopy, the Cormack-Lehane grading system and a new scale, the percentage of glottic opening (POGO) scale. Methods: Seven anesthesiologists from the University of Pennsylvania Health System viewed 25 identical pairs of slides of laryngeal views during direct laryngoscopy. Each anesthesiologist rated the 50 slides for both CormackLehane grades and POGO scores. The latter CL replaces grades I and 2 C-L grades with a percentage of glottic opening: the POGO score. Inter and intra-physician reliability for the Cormack-Lehane grades were determined using the kappa statistic analysis, comparison of POGO scores was performed using the intraclass correlation coefficients (r~). Results: The POGO score had a better inter and intra-physician reliability than the Cormack-Lehane grading system. The intra-physician reliability for the POGO score was very good with an average interclass r m value of 0.88. The inter-physician score was good with a r~ of 0.73. The Cormack-Lehane grading system had excellent intraphysician concordance (average kappa = 0.83.) but the inter-physician reliability was poor (kappa = 0.16.) Conclusion: The Cormack-Lehane grading system has very poor inter-physician reliability. The lack of interphysician reliability with Cormack-Lehane grading calls into question the results of previous studies in which different laryngoscopists used this method to assess laryngeal view. The POGO score appears to have good intra and inter-rater reliability. It has several theoretical advantages and may prove to be more useful for research studies in direct laryngoscopy. Object]f: Wrifler la fiabilit~ intra et interobservateur de deux m~thodes de classification de la vue du larynx pendant la laryngoscopie directe : le syst~me de cotation de Cormack-Lehane et une nouvelle &helle, le pourcentage d'ouverture glottique (POG). M~thode : Sept anesth&iologistes de I'University of Pennsylvania Health System ont visionn~ 25 paires identiques de diapositives du larynx sous laryngoscopie directe. Chaque anesth&iologiste a cot~ les 50 diapositives selon les &helons Cormack-Lehane et les scores POG. Cette derni&e &helle remplace les rangs I et 2 C-L par un pourcentage d'ouverture glottique : le score POG. La fiabilit~ inter et intraobservateur des rangs CormackLehane a ~t~ d&ermin& par une analyse statistique kappa, la comparaison des scores POG a ~t~ r~alis~e en utilisant des coefficients de correlation interclasses (r~). R~ltats : Le POG a foumi une meilleure fiabilit~ inter et intraobservateur que le syst~me de cotation CormackLehane. La fiabilit~ intraobservateur du score POG a ~t~ tr~s bonne, la valeur interdasse moyenne r~ ~tant de 0,88. Le score interobservateur a &~ bon selon un r~ de 0,73. Le syst~me de Cormack-Lehane a donn~ une excellente concordance intraobservateur (kappa moyen = 0,83) mais la fiabilit~ in...

Initiation of thoracic epidural analgesia prior to incision or the use of a muscle-sparing incision did not significantly impact pain or physical activity. Although women reported significantly greater pain during hospitalization and after discharge, they experienced fewer complications, were more likely to be discharged from the hospital sooner, and were just as active after discharge as men.

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