Ethnicity and upper airway measurements: A study in South Indian population

Balakrishnan, Kalpana; Chockalingam, Punitha

doi:10.4103/ija.ija_247_17

Cited by 23 publications

(28 citation statements)

References 31 publications

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“…[31314] In our study, RHTMD has higher sensitivity and accuracy, better specificity, and highest NPV. The sensitivity of RHTMD in our study was 62.5%, which was comparable with earlier studies,[14151617] but lower compared with some other studies, which could be due to lower cutoff value adopted. [4] The specificity of RHTMD was comparable with earlier reports.…”

Section: Discussionsupporting

confidence: 85%

“…[310] A recent study in south Indian population, attempted to find out the optimum airway measurements to predict difficult intubation, has reported a cutoff value of 17.1. [17] This is probably due to the higher mean TMD (9.03 cm) reported in the study. Though their sample size was good, the study could not provide optimum measurements for the predictive tests, as their best outcome being an area under ROC curve of 0.64 for RHTMD and all other indices giving a value <0.50.…”

Section: Discussionmentioning

confidence: 77%

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Ratio of height to thyromental distance as a predictor of difficult laryngoscopy: A prospective observational study

Kaniyil

Anandan

Thomas

2018

J Anaesthesiol Clin Pharmacol

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Background and Aim:Various airway indices are used either singly or in combination to predict difficult laryngoscopy. Recently introduced ratio of height to thyromental distance (RHTMD) is reported to have better predictability. We aimed to assess the prediction of difficult laryngoscopy by RHTMD and compared it with other indices.Material and Methods:In this prospective, single-blinded comparative observational study, 300 adult patients of either gender scheduled to receive general anesthesia were assessed. Airway indices, like RHTMD, thyromental distance, modified Mallampati test, and upper lip bite test, were assessed and correlated with Cormack and Lehane's laryngoscopic grading. The validity parameters like specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for each test. Effect of combining all the indices was also analyzed. Receiver operating characteristic curves were constructed and optimal cutoff value for the quantitative indices was calculated.Results:The incidence of difficult laryngoscopy in our study was 5.33%. Of the four indices, the single best test was RHTMD, with better sensitivity, high specificity, NPV, and accuracy and with good PPV. A combination of all the indices resulted in 100% sensitivity and higher specificity.Conclusions:RHTMD is a single best preoperative test for predicting difficult laryngoscopy. A combination of tests has higher sensitivity and specificity with better discriminative power. Therefore indices should be used in combination in the preoperative airway assessment of adult patients.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 77%

Ratio of height to thyromental distance as a predictor of difficult laryngoscopy: A prospective observational study

Kaniyil

Anandan

Thomas

2018

J Anaesthesiol Clin Pharmacol

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“…[9] In one of the studies done by Krishna et al (2005) which was done in Indian population, cut-off value was 21.3 cm. [15] Balakrishnan and Chockalingam (2017) in their study concluded a cut-off value of 17.1, [16] which was lower than our study population and in other Indian studies. [15,17,18] Probably, their study had predominantly female population and used TMD cut-off at (9.03 ± 1.2), which was 6.5 in our population.…”

Section: Discussioncontrasting

confidence: 57%

Is RHTMD a New Predictor for Assessment of Difficult Intubation in Non-Obese Patients?

Harjai¹,

Bhaskar²,

Saxena³

et al. 2018

jemds

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BACKGROUND The recognition of difficult intubation during pre-operative check-up is very important for the anaesthesiologist. Various anatomical parameters assist in predicting difficult intubation. Till date, there are no predictors available to precisely assess the risk of difficult intubation, pre-operatively.Therefore, we aim to identify the adequacy of predictors for preoperative assessment of difficult intubation. MATERIALS AND METHODSAfter ethical approval of Institutional Ethics Committee, a total of 200 non-obese patients (Body mass index less than or equal to 30) were recruited in this prospective observational study after obtaining informed consent. Mouth Opening (MO), Modified Mallampati Grading (MMG), neck circumference (cm), Thyromental Distance (TM), Sternomental Distance (SM), Neck Movement (NM), Neck Circumference (NC) and Ratio of Height to Thyromental Distance (RHTMD) were measured pre-operatively. In each patient, validated Intubation Difficulty Score (IDS score) was assessed intraoperatively by the anaesthetist. All patients were divided into two groups on the basis of easy (IDS score < 5) and difficult intubation (IDS score ≥ 5). Multivariate logistic regression analysis including all variables was used to create a predictive model. RESULTSLaryngoscopy was difficult in 12.0% of the patients. The MO, MMG, NM, NC, TM, SM, NC/TM were significantly different in between easy and difficult intubation. The Area Under Curve (AUC) in ROC for the TM, SM, NC/TM, RHTMD and MPC were 0, 270, 0.138, 0.848, 0.807 and 0.699, respectively. Among all indices, NC/TM and RHTMD were found to have high sensitivity and specificity. NC/TM was showing maximum area under the curve on ROC curve (AUC) followed by RHTMD. CONCLUSIONAmong non-obese patients, NC/TMD ratio and RHTMD can be used for better predictor of difficult intubation, pre-operatively.

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“…Future studies should try and define ethnicity-specific cutoffs and validate them as there are variations in craniofacial features and body habitus across different races. [ 21 22 ] TMHT data on caucasian population is lacking. The ideal way of measuring the airway parameters should be defined and pilot testing for interobserver variablity should be strongly encouraged before embarking clinical evaluation.…”

Section: Discussionmentioning

confidence: 99%

Validity of thyromental height test as a predictor of difficult laryngoscopy: A prospective evaluation comparing modified Mallampati score, interincisor gap, thyromental distance, neck circumference, and neck extension

et al. 2018

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Background and Aims:Thyromental height test (TMHT) is a recently described anatomical bedside screening tool in predicting difficult laryngoscopy. It has been shown to be more accurate than the modified Mallampati score, thyromental distance (TMD), and sternomental distance with regard to sensitivity and positive predictive value (PPV). Airway assessment studies based on the anatomic parameters of the upper airway are limited in the subcontinent population. We attempted this study to evaluate and validate the predictive value of TMHT at 50 mm in an Indian population in predicting difficult laryngoscopy.Methods:This prospective observational study was conducted in a tertiary teaching hospital on 340 patients. TMHT along with other bedside predictors of difficult intubation, including modified Mallampati score, interincisor gap (IIG), TMD, neck circumference (NC), and neck extension were assessed. We compared the sensitivity, specificity, PPV, negative predictive value (NPV), and diagnostic accuracy of TMHT with other bedside tests such as the modified Mallampati score, IIG, TMD, NC, and neck extension individually in predicting difficult laryngoscopy. Any Cormack and Lehane's intubation grade II b and above was considered to be difficult laryngoscopy.Results:TMHT had the highest sensitivity (84.62%) and specificity (98.97%), and had the most PPV (88%) and NPV (98.63%) when compared with the modified Mallampati score, IIG, TMD, NC, and neck extension. TMHT was followed by the modified Mallampati score and IIG.Conclusion:TMHT appears promising as a single anatomical measure to predict the risk of difficult laryngoscopy, however, validation will require further studies in more diverse patient populations.

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Ethnicity and upper airway measurements: A study in South Indian population

Cited by 23 publications

References 31 publications

Ratio of height to thyromental distance as a predictor of difficult laryngoscopy: A prospective observational study

Ratio of height to thyromental distance as a predictor of difficult laryngoscopy: A prospective observational study

Is RHTMD a New Predictor for Assessment of Difficult Intubation in Non-Obese Patients?

Validity of thyromental height test as a predictor of difficult laryngoscopy: A prospective evaluation comparing modified Mallampati score, interincisor gap, thyromental distance, neck circumference, and neck extension

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