Evaluation of different airway tests to determine difficult intubation in apparently normal adult patients undergoing surgical procedures.

El-Radaideh, Khaled M.; Dheeb, Ehab; Shboul, Hamzeh; Garaibeh, Saif; Bataineh, Adel; Khraise, Wail; Radaideh, Basil EL

doi:10.21203/rs.3.rs-35721/v2

Cited by 2 publications

(2 citation statements)

References 23 publications

(33 reference statements)

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“…The deficiency of equipment and facilities will affect patient monitoring in turn, which is one of the greatest barriers to access safe anesthesia. Evidences suggest that patient monitoring by clinical observation, clinical examination, and using a combination of essential monitoring device increases perioperative patient outcome and safety [20,28,29]. Clinical observation encompasses measuring pulse rate and quality, seeing tissue oxygenation and perfusion, measuring respiratory rate and quality, observing breathing system bag movement, hearing breath sounds, hearing heart sounds and assessing pain level.…”

Section: Discussionmentioning

confidence: 99%

The current state of anesthesia safety in a third world country: a cross-sectional survey among anesthesia providers in Ethiopia

Mihretu

2021

Patient Saf Surg

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Background Improving patient safety during anesthesia and surgery becomes a major global public health issue due to the increasing in surgical burden. Anesthesia is delivered safely in developed countries, but its safety is hampered by complex problems in third world countries. This survey assesses the unmet anesthesia needs of one of a third world country, Ethiopia. Methods A cross-sectional survey was conducted in Amhara region of Ethiopia from 15/12/2019 to 30/1/2020. All 81 hospitals of the region were stratified by their level as district, general, and referral hospital. The study was conducted in 66 hospitals. The number of hospitals from each strata were calculated by proportional sampling technique resulting; five referral, three general, and fifty eight primary hospitals. Each hospital from each strata was selected by convenience. Each anesthesia provider for the survey was selected randomly from each hospital and questionnaires were distributed. The minimum expected safe anesthesia requirements were taken from World Health Organization-World Federation of Societies of Anesthesiologists International Standard and Ethiopian Hospitals Standard. Anesthesia practice was expected safe if the minimum requirements were practiced always (100%) in each hospital. P < 0.05 with 95% confidence interval were used to compare the safety of anesthesia between higher and lower level hospitals. Results Seventy eight (88.6%) anesthesia providers working in 62 hospitals responded to the survey. On aggregate, 36 (58%) hospitals from the total 62 hospitals have met the minimum expected safe anesthesia requirements. Among the different variables assessed; professional aspects 32 (52.45%), medication and intravenous fluid 33 (53.36%), equipment and facilities 33 (52.56%), patient monitoring 43(68.88%), and anesthesia conduct 38 (62.1%) of surveyed hospitals have met the minimum requirements. Anesthesia safety is relatively higher in higher level hospitals (general and referral) 6 (75%) when compared to district hospitals 30 (55.5%), P < 0.001. Conclusion Anesthesia safety in Ethiopia appears challenged by substandard continuous medical education and continuous professional development practice, and limited availability of some essential equipment and medications. Patient monitoring and anesthesia conduct are relatively good, but World Health Organization surgical safety checklist application and postoperative pain management are very low, affecting the delivery of safe anesthesia conduct.

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Section: Discussionmentioning

confidence: 99%

The current state of anesthesia safety in a third world country: a cross-sectional survey among anesthesia providers in Ethiopia

Mihretu

2021

Patient Saf Surg

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“…3. This has led to the requirement for extremely accurate tests for the detection of difficult-to-manage airways during anaesthetic and surgical procedures.. 5 Difficult airway and related morbidity can be reduced if it could be predicted correctly during the preoperative assessment 6 . Airway assessment includes a detailed history a careful physical examination and in certain cases inspection of relevant x-ray 3 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Modified Mallampati Classification and Thyromental Height to Predict Difficult Intubation

Aslam¹,

Ahmed²,

Ali³

et al. 2023

PJMHS

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Introduction: Difficult intubation is an emergency situation that an anaesthetist come across frequently. It is a frequent cause of mortality in practice of anesthesia. Mallampati classification (MPC) of the oropharyngeal structures is a simple test to assess anticipated difficult airway for endotracheal intubation. thyromental height (TMH) test is now also commonly used to predict difficult intubation. Objective: To evaluate diagnostic accuracy of modified mallampati classification and thyromental height using Cormack and Lehane's classification of laryngoscopy as a gold standard. Study Design: Descriptive cross sectional validation study. Setting: Department of Anaesthesia, Benazir Bhutto Hospital, Rawalpindi. Duration: 20-Sep-2021 to 19-Mar-2022. Material and Methods: A total number of 1035 were included in this study. Pre-operatively modified Mallampati test (MMT) and TMH test was performed. Mallampati class III and IV were considered difficult. While TMH height >50 mm was considered as difficult intubation. Difficult intubation equipment’s was ready, i.e. stylet, boogie, LMA, I-gel. General anaesthesia was induced in the operating room after collecting baseline vital signs. After three minutes, a skilled anesthesiologist performed a laryngoscopy while the patient was sniffing. To validate the diagnosis of difficult intubation, the laryngeal view was appraised using a modified Cormack and Lehane (C-L) grading system. Results: Mean age of patients was 40.16±12.19 years. Mean height of patients was 152.94±8.32 cm, mean weight was 65.01±13.59 Kg and Mean body mass index (BMI) was 27.78±5.64 kg/m2. There were 768 (74.20%) males and 267 (25.80%) females. TMH was 77.8% sensitive, 94.6% specific having 70.0% PPV, 96.3% NPV and 92.27% accuracy. On diagnostic accuracy of MMP taking difficult intubation according to standard as gold standard, MMP was 92.4% sensitive, 90.1% specific having 60.2% PPV, 98.6% NPV and 90.3% accuracy. Practical implications: Thyromental Height (TMH) needs more broad usage in multiple settings to be validated as a single most important predictor of difficult laryngoscopy. It will thus be used widely all over the country rendering fewer complications for the patients. Conclusion: TMH was the test that was most sensitive and accurate at foretelling difficult laryngoscopy when compared to the modified Mallampati score. TMH has potential as a single anatomical metric to predict the possibility of a difficult laryngoscopy. Keywords: Mallampati classification, thyromental height, Cormack and Lehane's classification, laryngoscopy.

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Evaluation of different airway tests to determine difficult intubation in apparently normal adult patients undergoing surgical procedures.

Cited by 2 publications

References 23 publications

The current state of anesthesia safety in a third world country: a cross-sectional survey among anesthesia providers in Ethiopia

The current state of anesthesia safety in a third world country: a cross-sectional survey among anesthesia providers in Ethiopia

Comparison of Modified Mallampati Classification and Thyromental Height to Predict Difficult Intubation

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