Practice Guidelines for Management of the Difficult Airway

Apfelbaum, Jeffrey L.; Blitt, Casey D.; Nickinovich, David G.; Hagberg, Carin A.; Caplan, Robert A.; Benumof, Jonathan L.; Berry, Frederic A.; Bode, Robert H.; Cheney, Frederick W.; Connis, Richard T.; Guidry, Orin F.; Ovassapian, Andranik

doi:10.1097/aln.0b013e31827773b2

Cited by 1,866 publications

(725 citation statements)

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“…Many national airway guidelines underline the importance of a thorough and skilled airway assessment of all patients before undergoing anaesthesia 11, 12. The modified Mallampati test (MMT) is the most popular test for screening difficult laryngoscopy, but there is controversy regarding its accuracy.…”

Section: Discussionmentioning

confidence: 99%

Radiologic indicators for prediction of difficult laryngoscopy in patients with cervical spondylosis

Han

Tian

Zhang

et al. 2018

Acta Anaesthesiol Scand

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BackgroundWe identified the most useful variables for prediction of difficult laryngoscopy in patients with cervical spondylosis according to physical indicators and preoperative skeletal X‐ray and soft tissue MRI measurements. We hypothesized that there was a closer association between difficult laryngoscopy and radiologic indicators.MethodsWe randomly enroled 315 patients undergoing elective cervical spine surgery and analysed the radiological and physical data in predicting difficult laryngoscopy.ResultsWe identified five variables that were most useful in predicting difficult laryngoscopy: the inter‐incisor gap (P = 0.006), modified Mallampati test score (P = 0.004), distance from the highest point of the hyoid bone to the mandibular body (P < 0.001), most antero‐inferior point of the upper central incisor tooth (P < 0.001), and length of the epiglottis (P = 0.002). Binary multivariate logistic regression analyses identified three factors that were independently associated with difficult laryngoscopy: the Mallampati score, distance from the hyoid bone to the mandibular body, and the anterior–inferior point of the upper central incisor tooth. The odds ratios and 95% confidence intervals were 1.547 (1.029–2.327), 1.222 (1.139–1.310), and 1.224 (1.133–1.322), respectively. The AUC for hyoid bone distance to mandibular body (0.832) was larger than that of anterior‐inferior point of the upper central incisor tooth (0.802, P > 0.05) and that of modified Mallampati test (0.602, P < 0.05).ConclusionDistance from the highest point of the hyoid bone to the mandibular body appears to be the most accurate indicator for difficult laryngoscopy in patients with cervical spondylosis.

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Section: Discussionmentioning

confidence: 99%

Radiologic indicators for prediction of difficult laryngoscopy in patients with cervical spondylosis

Han

Tian

Zhang

et al. 2018

Acta Anaesthesiol Scand

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“…19 This recommendation was modified in the latest guidelines to include assessment for possible difficult surgical airway access. 9 An initial step toward improved outcomes when performing an emergency cricothyrotomy should include formulating a reliable clinically validated technique for identifying the CTM. The primary aim of this study was to compare the success rates of anesthesia providers vs trauma surgeons in their use of palpation to identify the CTM.…”

Section: Résumémentioning

confidence: 99%

“…[6][7][8] The most recent American Society of Anesthesiologists' (ASA) "Practice Guidelines for Management of the Difficult Airway" designate surgical or percutaneous airway, jet ventilation, or retrograde intubation as invasive airway access procedures to secure the airway in both non-emergency and emergency situations. 9 Each of these techniques is usually performed at the cricothyroid membrane (CTM). Furthermore, if creation of an emergency surgical airway is necessary, anesthesiologists are more likely to perform a percutaneous cricothyrotomy than either a surgical cricothyrotomy or a tracheostomy.…”

Section: Résumémentioning

confidence: 99%

Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

Hiller

Karni

Cai

et al. 2016

Can J Anesth/J Can Anesth

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“…There are several alternative techniques that can be used in patients who experience breathing difficulty during intubation [12]. As in this case, videoscopes have advantages such as a rapid learning curve, ease of use by novices, increased first-attempt success and decreased time to intubation, minimal head or neck manipulation, and favoring communication between the different specialists involved in the treatment by allowing multi-person visualization [10,13].…”

Section: Discussionmentioning

confidence: 99%