A prospective observational study of predictors of difficult intubation in Indian patients

Narkhede, Harsha; Patel, Ruchit; Narkhede, Hemraj

doi:10.4103/joacp.joacp_269_17

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Observational studies reported comparative findings for facial and jaw features and anatomical measurement for difficult versus nondifficult airway patients as well as sensitivity, specificity, positive predictive, negative predictive, and accuracy values for difficult laryngoscopy and intubation. Findings for facial and jaw features, 7–11,13,14,18,27,33,38–40,42,43,45–47,49,51–54,57,58,64,68,123–159 anatomical measurements, 7–11,13–15,18,22,23,27–30,33,35,37–40,45–47,49,51–54,57,58,60, 64,65,68,70,123–132,134–154,156,158–203 and ultrasound anatomical measurements 69,139,162,170,194,196,203–213 were shown to have very high predictive and comparative variability, with sensitivity, specificity, and significance values ranging from low to very high across all patient measures (Category B2-E evidence). No single characteristic was identified as consistently being more predictive than another, and multivariate measures intended to predict difficult airways were too few and diverse among the studies to determine a common set of predictors.…”

Section: Guidelinesmentioning

confidence: 99%

“…Findings for the above patient characteristics were shown to have very high predictive and comparative variability, with sensitivity, specificity, and significance values ranging from low to very high across all patient demographic measures (Category B2-E evidence). 6–70 No single characteristic was identified as consistently being more predictive than another, and multivariate measures intended to predict difficult airways were too few and diverse among the studies to determine a common set of predictors.…”

Section: Guidelinesmentioning

confidence: 99%

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2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

Apfelbaum¹,

Hagberg²,

Connis³

et al. 2021

Anesthesiology

604

547

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The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care, Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.

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Section: Guidelinesmentioning

confidence: 99%

Section: Guidelinesmentioning

confidence: 99%

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

Apfelbaum¹,

Hagberg²,

Connis³

et al. 2021

Anesthesiology

604

547

View full text Add to dashboard Cite

show abstract

“…В 2019 г. Harsha Narkhede опубликовал исследование, включившее информацию о 483 пациентах. Было показано, что ограничение подвижности шейного отдела позвоночника повышает риск ТИ (чувствительность -78,6 %, специфичность -82,8 %) [42].…”

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Diagnosis of difficult airways: a review

Zaytsev,

Usikyan,

Dubrovin

et al. 2023

Annals of Critical Care

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INTRODUCTION: Complications arising from maintaining the patency of the upper airways in the practice of an anesthetist remain the most dangerous for the life and health of the patient. The problem of predicting difficult airways has been studied for decades and has not yet been solved. OBJECTIVE: To analyze the problem of the difficult airways diagnosis. MATERIALS AND METHODS: There was search on PubMed (MEDLINE), eLibrary, Google Scholar databases for the period 01.1985–01.2022. Keywords: Difficult airways prediction, difficult airways, difficult intubation, mask ventilation, endoscopy intubation, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), difficult airways, difficult intubation, difficult laryngoscopy, mask ventilation, ultrasound diagnostics, computed tomography (CT), magnetic resonance imaging (MRI). Inclusion criteria: original, review articles, randomized and non-randomized clinical trials, meta-analyses and systematic reviews devoted to the diagnosis of TDP. Exclusion criteria: clinical cases, comments on articles, abstracts of dissertations. RESULTS: Measurement of various distances, tests for congenital or acquired deformity of the facial skull and malocclusion, tests for the relationship between the structures of the facial skull and the cervical spine, for the most part, have limited diagnostic effectiveness. The instrumental methods allows diagnosing difficult airways with greater confidence. The thickness of the tongue, the distance from the skin to the epiglottis or vocal folds, and the long epiglottis can accurately predict difficulties at various stages of maintaining airways from face mask ventilation to laryngoscopy and tracheal intubation. Ultrasonography should be considered the most optimal method for diagnosing difficult airways. At the same time, less accurate indicators compared to magnetic resonance and x-ray studies should not stop clinicians, as they are compensated by a faster examination. CONCLUSIONS: Instrumental methods for difficult airways diagnosis are more effective than physical ones.

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Comparison of airway ultrasound indices and clinical assessment for the prediction of difficult laryngoscopy in elective surgical patients: A prospective observational study

et al. 2021

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Background: Ultrasound is evolving as a probable tool in airway assessment. The upper airway is a superficial structure and has sonographically identifiable structures which makes it ideal for evaluation with the ultrasound. Aims: The aim of this study was to evaluate the role of skin to hyoid and skin to thyrohyoid membrane distance in prediction of difficult laryngoscopy. Settings and Design: This is a prospective observational study included 150 patients aged 18–60 years of American Society of Anesthesiologists Physical Status I and II scheduled to undergo surgery under general anesthesia requiring laryngoscopy and endotracheal intubation. Materials and Methods: The modified Mallampati score, mouth opening, mentohyoid distance, thyromental distance were noted. Skin to hyoid bone distance and skin to thyrohyoid membrane distance were measured by ultrasound. Patients were clubbed retrospectively into easy and difficult laryngoscopy groups on the basis of Cormack Lehane grading, and the characteristics of both groups were compared. Statistical Analysis: Statistical Package for the Social Sciences, Version 23 was used for statistical analysis. Independent samples t -test was used to compare the means between difficult and easy laryngoscopy patients. Diagnostic accuracy of the significant ( P < 0.05) variables between difficult and easy laryngoscopy patients was calculated using receiver operating characteristics curve in terms of their area under curve. Appropriate cutoff values (with corresponding sensitivity, specificity, and overall accuracy) were also identified. Results: Out of 150 patients, 13 (8.7%) were identified as difficult laryngoscopy whereas 137 patients (91.3%) were identified as easy laryngoscopy. The demographics of both groups were comparable. Mentohyoid distance, skin to hyoid bone distance, and skin to thyrohyoid distance were statistically different between easy and difficult laryngoscopy patients, with lower mentohyoid distance and higher skin to hyoid bone distance and skin to thyrohyoid distance in difficult laryngoscopy patients. Diagnostic accuracy of the mentohyoid distance (70.3%) was slightly superior to skin to hyoid bone distance (67.1%) and skin to thyrohyoid distance (68.1%). Conclusion: Ultrasound measurements of skin to hyoid bone and skin to thyrohyoid membrane distance fail to eclipse clinical parameters in accurately predicting a difficult laryngoscopy.

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A prospective observational study of predictors of difficult intubation in Indian patients

Cited by 3 publications

References 9 publications

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

Diagnosis of difficult airways: a review

Comparison of airway ultrasound indices and clinical assessment for the prediction of difficult laryngoscopy in elective surgical patients: A prospective observational study

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