Neck circumference to thyromental distance ratio: Is a reliable predictor of difficult intubation in obese patients?

Ankalwar, Vrishali; Patel, Manish I.; Tirpude, Naresh G.

doi:10.18231/2394-4994.2019.0029

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…p-value <0.029, odds ratio 4.52). 16 In another study conducted by Khanooja et al, in 2016, it was concluded that NC/TM ratio was a good predictor of difficult intubation than the malampatti score. 17 We also agreed with Siyam et al, where the difficulty in intubation incidence in obese patients having sleep apnoea syndrome is 21.9%.…”

Section: Discussionmentioning

confidence: 94%

Significance of Ratio of the Neck Circumference and Thyromental Distance as a Predictor of Difficult Intubation in Obese Patients

Qureshi¹,

Khan²,

Malik³

et al. 2022

PAFMJ

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Objective: To ascertain the diagnostic accuracy of raised neck circumference to thyromental distance ratio (NC/TMD) for difficulty in intubation among patients with obesity keeping grades III and IV of Cormack and Lehane's score as the gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Anesthesiology Department, Combined Military Hospital Rawalpindi, from Jul to Dec 2017. Methodology: One hundred and thirty obese patients who had to undergo surgery under general anaesthesia were included in the study. All the patients underwent measurement of neck circumference to thyromental distance ratio, and raised neck circumference to thyromental distance ratio was noted. Difficult intubation was labelled according to the grades III and IV of Cormack and Lehane's score. Results: In this study, 130 cases were included. Fifty-eight patients were males, and 72 were females. Diagnostic accuracy of raised neck circumference to thyromental distance ratio for difficulty in intubation among patients who were obese, was recorded where sensitivity was 83.87%, and specificity was found to be 91.92%, positive predictive value as 76.47%, negative predictive value as 94.79%, the accuracy rate was calculated as 90%. Conclusion: Our study showed that difficulty in intubation is more frequent in patients who are obese and the neck circumference to thyromental distance ratio is a reliable method for foreseeing difficult intubation compared to other established predictors with cut off value of 5.0.

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Section: Discussionmentioning

confidence: 94%

Significance of Ratio of the Neck Circumference and Thyromental Distance as a Predictor of Difficult Intubation in Obese Patients

Qureshi¹,

Khan²,

Malik³

et al. 2022

PAFMJ

View full text Add to dashboard Cite

show abstract

“…A previous study on obese patients observed similar sensitivity and NPV. [ 17 ] Kim et al . [ 6 ] also observed high sensitivity and NPV similar to our study in obese patients, but they found a higher specificity.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of neck-circumference- thyromental- distance ratio as a predictor of difficult intubation: A prospective, observational study

Pradeep,

Bhar Kundu,

Nivetha

2023

Indian Journal of Anaesthesia

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Background and Aims: Preoperative identification of difficult airway and subsequent planning is of utmost importance for a patient’s safety. Previous studies have identified the ratio of the neck circumference (NC) to the thyromental distance (TMD); NC/TMD as a reliable predictor of difficult intubation in obese patients. But there is a lack of studies evaluating the NC/TMD in non-obese patients. Therefore, the aim of this study was to compare the NC/TMD as a predictor of difficult intubation in both obese and non-obese patients. Methods: A prospective, observational study was conducted after obtaining institutional ethics committee clearance and written and informed consent from each patient. One hundred adult patients undergoing elective surgeries under general anaesthesia with orotracheal intubation were included in this study. Difficulty in intubation was assessed using the Intubation Difficulty Scale. The NC/TMD was calculated and the predictive accuracy of NC/TMD and other established parameters in obese and non-obese patients were compared. Results: Univariate logistic regression analysis showed that gender, weight, body mass index, inter-incisor gap, Mallampati classification, NC, TMD, sternomental distance, and NC/TMD had a significant association with difficult intubation. NC/TMD has a higher sensitivity, specificity, and positive and negative predictive value with better predictability in comparison to other parameters. Conclusion: The NC/TMD is a reliable and better predictor of difficult intubation in both obese and non-obese patients in comparison to NC, TMD, and sternomental distance alone.

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The effect of capnography on the incidence of hypoxia during sedation for EGD and colonoscopy in mildly obese patients: a randomized, controlled study

et al. 2023

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Background By continually monitoring end-tidal carbon dioxide concentrations, capnography can detect abnormal ventilation or apnoea early. This randomized, controlled study explored the effect of early intervention with capnography on the incidence of hypoxia in mildly obese patients undergoing sedation for esophagogastroduodenoscopy (EGD) and colonoscopy. Methods This is a single-center, randomized, single-blind, parallel-assignment, controlled trial. Mildly obese patients (28 kg/m2 ≤ BMI < 40 kg/m2) undergoing sedation for EGD and colonoscopy were randomly assigned to either the standard or capnography group. Standard cardiopulmonary monitoring equipment was used in both groups, and additional capnography was performed in the capnography group. In the event of inadequate alveolar ventilation during sedation, five interventions were administered in sequence (a-e) : a: increasing oxygen flow (5 L/min); b: a chin lift or jaw thrust maneuver; c: placement of the nasopharyngeal airway and chin lift; d: mask positive-pressure ventilation, and e: ventilator-assisted ventilation with tube insertion. The primary outcome was the incidence of hypoxia (SpO2 < 90%, ≥ 10 s) in each group. The secondary outcomes included the incidence of severe hypoxia (SpO2 ≤ 85%), subclinical respiratory depression (90% ≤ SpO2 < 95%), interventions, minimum SpO2 during operation, patient satisfaction, endoscopist satisfaction, and other adverse events of anesthesia sedation. Results 228 patients were included (capnography group = 112; standard group = 113; three patients were excluded) in this study. The incidence of hypoxia was significantly lower in the capnography group than in the standard group (13.4% vs. 30.1%, P = 0.002). Subclinical respiratory depression in the capnography group was higher than that of the standard group (30.4% vs. 17.7%, P = 0.026). There was only a 5.4% incidence of severe hypoxia in the capnography group compared with 14.2% in the standard group (P = 0.026). During sedation, 96 and 34 individuals in the capnography and standard groups, respectively, underwent the intervention. There was a statistically significant difference (P < 0.0001) in the number of the last intraoperative intervention between the two groups ( a:47 vs. 1, b:46 vs. 26, c:2 vs. 5, d:1 vs. 2, e:0 vs. 0 ). No significant differences were found between the two groups in terms of minimum SpO2 during operation, patient satisfaction, or endoscopist satisfaction rating. There was no statistically significant difference in adverse events of anesthesia sedation between the two groups. Conclusion Capnography during sedation for EGD and colonoscopy allows for the detection of apnea and altered breathing patterns in mildly obese patients before SpO2 is reduced. Effective intervention measures are given to patients within this time frame, which reduces the incidence of hypoxia and severe hypoxia in patients. Trial registration Ethical approval was granted by the Medical Ethics Committee (Chairperson Professor Tian Hui) of Qilu Hospital, Shandong University ((Ke) Lun Audit 2021 (186)) on 15/07/2021. The study was registered (https://www.chictr.org.cn) on 23/10/2021(ChiCTR2100052234). Designed and reported using CONSORT statements.

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Neck circumference to thyromental distance ratio: Is a reliable predictor of difficult intubation in obese patients?

Cited by 4 publications

References 6 publications

Significance of Ratio of the Neck Circumference and Thyromental Distance as a Predictor of Difficult Intubation in Obese Patients

Significance of Ratio of the Neck Circumference and Thyromental Distance as a Predictor of Difficult Intubation in Obese Patients

Evaluation of neck-circumference- thyromental- distance ratio as a predictor of difficult intubation: A prospective, observational study

The effect of capnography on the incidence of hypoxia during sedation for EGD and colonoscopy in mildly obese patients: a randomized, controlled study

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