No radiographic index predicts difficult intubation using the Optiscope™ in cervical spine surgery patients: a retrospective study

Abstract

Background: The Optiscope™ can be used for intubation with minimal neck motion. We retrospectively investigated radiographic predictors of difficult intubation using the Optiscope™ by analyzing preoperative radiographic images. Methods: One hundred eighty-four patients who were intubated with the Optiscope™ under manual in-line cervical stabilization for cervical spine surgery were enrolled. Radiographic indices were measured on preoperative cervical spine lateral X-ray and magnetic resonance imaging images. Difficult intubation was defined as failure or time consumption more than 90 s on the first attempt. To identify significant predictors of difficult intubation using the Optiscope™ and evaluate their diagnostic value, multivariable logistic regression and receiver operating characteristic analyses were used. Results: Fourty-seven patients showed difficult intubation. There was no significant difference in radiographic indices between the difficult and easy intubation groups, but higher body mass index (BMI) (26.5 [3.0] vs. 24.6 [3.5] kg/m 2 , P = 0.001), shorter sternomental distance (SMD) (122.0 [104.0 to 150.0] vs. 150.0 [130.0 to 170.0] mm, P = 0.001), shorter interincisor gap (40.0 [35.0 to 45.0] vs. 43.0 [40.0 to 50.0] mm, P = 0.006), and higher incidence of excessive oral secretions (10.6% vs. 2.9%, P = 0.049) were observed in patients with difficult intubation. In multivariable analysis, BMI (odds ratio [95% confidence interval]; 1.15 [1.03 to 1.28], P = 0.011) and SMD (odds ratio [95% confidence interval]; 0.98 [0.97 to 1.00], P = 0.008) were associated with difficult intubation with the Optiscope™. In receiver operating characterstic analysis, the area under the curve for body mass index was 0.68 (95% confidence interval; 0.60 to 0.77, P < 0.001) and that for sternomental distance was 0.66 (95% confience interval; 0.57 to 0.75, P = 0.001). Conclusions: The incidence of difficult intubation using the Optiscope™ under manual in-line cervical stabilization was 25.5% in cervical spine surgery patients. No significant predictor of difficult intubation with the Optiscope™ was identified among the measured radiographic indices. Although high BMI and short SMD were predictive of difficult intubation with the Optiscope™, their discrimination power was weak.

The effects of backward, upward, rightward pressure maneuver for intubation using the OptiscopeTM: a retrospective study

“…Secondly, a previous study demonstrated that the area under the curve of 0.66 for SMD was predictive of difficult intubation using the Optiscope TM [4]. This study found that the discrimination power mentioned previously is less than acceptable, suggesting that the importance of SMD as a predictor of difficult intubation with the Optiscope TM might be clinically insignificant.…”

“…In addition, SMD is an indicator for neck mobility and extension [14]. Full extension of the neck makes the alignment of the oropharyngeal axes more horizontal creating an ideal environment for laryngoscopy [4]. Thus we hypothesized that longer SMD would shorten intubation time when using the Optiscope TM .…”

“…Whenever the intubation time reached 90 seconds or the SpO 2 < 90%, the attempt was ceased and manual ventilation was performed for 1 min with 100% oxygen [10]. Failed tracheal intubation was defined as failure to secure the airway with three consecutive attempts [4,10]. Upon failing to intubate, alternative devices such as fiberoptic bronchoscope or Pentax-AWS ® were used, and the corresponding suspect was excluded.…”

“…intubation to be performed while visualizing the patient's larynx through the monitor [1,4]. The monitor of the Optiscope TM is fixed to the handle, thus providing the anesthesiologist a more comfortable and desirable posture during intubation [1].…”

Trends in Preoperative Airway Assessment

“…Poor visualization of the glottis during a classical laryngoscopy has been associated with changes in the shape and size of the mandible, degenerative processes of the atlantoaxial or atlantooccipital joint in the context of general pathology, and a maxillopharyngeal angle of less than 90° [ 68 , 70 , 71 ]. Radiographic images should be reviewed by anesthetists whenever available, but given the low sensitivity and specificity of radiography-derived parameters, it is questionable whether patients should be exposed to unnecessary irradiation for an airway evaluation alone [ 72 , 73 ]. Radiography might be particularly useful in places where ultrasound is not accessible or there is no proficiency in its use.…”