Predicting Difficult Intubation

Wilson, Michael E.; Spiegelhalter, D; Robertson, Jan; Lesser, P.

doi:10.1097/00132582-198907000-00021

Cited by 110 publications

(134 citation statements)

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“…It was then categorized as 4 cm (score 0) or < 4 cm (score 1); TMD was measured along a straight line from the thyroid notch to the lower border of the mandibular symphysis with the head fully extended (Fig. 1a), and categorized as > 6.5 cm (score 0), between 6 and 6.5 cm (score 1), or < 6 cm (score 2); Upper jaw dental status was scored 0 in edentulous subjects, 1 in partially edentulous, 2 in presence of normal teeth, and 3 in case of prominent superior teeth; Trismus was scored 0 if absent and 1 when present; Mandibular prognathism was considered as the position of the lower incisors in front of the upper ones, and was scored 0 when absent or reducible, and 1 when present and not reducible; Macroglossia was considered as the situation in which patient's tongue fills the entire oral cavity, and was scored 0 if absent and 1 when present; Micrognathia was scored 0 when absent and 1 if present; Degree of neck flexion-extension was measured as described by Wilson et al 2 by asking the patient to extend the neck and then measuring the arc from this position to that of full flexion of the neck on chest (Fig. 1b, c).…”

Section: Methodsmentioning

confidence: 99%

Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: The laryngoscore

Piazza¹,

Mangili²,

Bon³

et al. 2014

The Laryngoscope

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Objectives/Hypothesis: To identify a clinical predictor score for difficult laryngeal exposure (DLE) during operative microlaryngoscopy.Study Design: Prospective cohort study in two academic institutions. Methods: We evaluated 319 patients before microlaryngoscopy for benign and malignant glottic diseases by a standardized preoperative assessment protocol (Laryngoscore) that included 11 parameters: interincisors gap (IIG), thyro-mental distance, upper jaw dental status, trismus, mandibular prognathism, macroglossia, micrognathia, degree of neck flexionextension, history of previous open-neck and/or radiotherapy, Mallampati's modified score, and body mass index (BMI). Each parameter was assessed to obtain a total score. Patients were divided into five classes according to the anterior commissure (AC) visualization: class 0, complete AC visualization with large-bore laryngoscopes in the Boyce-Jackson position; class I, as class 0 with external laryngeal counterpressure; class II, as class I in the flexion-flexion position; class III, as class II using small-bore laryngoscopes; and class IV, impossible AC visualization.Results: Class 0-I-II (good/acceptable laryngeal exposure) presented a median score < 6. This value was chosen as cutoff for distinguishing favorable versus difficult/impossible laryngeal exposures. When the Laryngoscore was < 6, good laryngeal exposure was observed in 94% of patients, whereas when 6, DLE was encountered in 40%. When considering a Laryngoscore of 9, 67% of patients had a DLE. At univariate analysis, IIG, upper jaw dental status, macroglossia, micrognathia, degree of neck flexion-extension, and BMI statistically impacted on DLE (P < 0.05).Conclusions: The Laryngoscore is a good predictor of DLE and assists in selecting the ideal candidates for operative microlaryngoscopy.

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Section: Methodsmentioning

confidence: 99%

Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: The laryngoscore

Piazza¹,

Mangili²,

Bon³

et al. 2014

The Laryngoscope

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“…The following preoperative risk factors for difficult tracheal intubation were recorded: modified Mallampati class, dental status, presence of retrognathism (side-view of patient reveals chin as being posterior to the plane of the face), inability to prognate, interincisal distance (or intergingival distance in toothless patients), thyromental and sternomental distances. [7][8][9][10][11][12] Experimental protocol…”

Section: Methodsmentioning

confidence: 99%

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Thiboutot

Nicole

Trépanier

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Although manual in-line stabilization (MILS) is commonly used during endotracheal intubation in patients with either known or suspected cervical spine instability, the effect of MILS on orotracheal intubation is poorly documented. This study evaluated the rate of failed tracheal intubation in a fixed time interval with MILS. Methods Two hundred elective surgical patients were randomized into two groups. In the MILS group, the patient's head was stabilized in a neutral position by grasping the patient's mastoid processes to minimize any head movement during tracheal intubation. In the control group, the patient's head rested in an optimal position for tracheal intubation. A 30-sec period was allowed to complete tracheal intubation with a #3 Macintosh laryngoscope blade. The primary endpoint was the rate of failed tracheal intubation at 30 sec. Secondary endpoints included tracheal intubation time and the Cormack & Lehane grade of laryngoscopy.Results Patient characteristics were similar with respect to demographic data and risk factors for difficult tracheal intubation. The rate of failed tracheal intubation at 30 sec was 50% (47/94) in the MILS group compared to 5.7% (6/ 105) in the control group (P \ 0.0001). Laryngoscopic grades 3 and 4 were more frequently observed in the MILS group. Mean times for successful tracheal intubation were 15.8 ± 8.5 sec and 8.7 ± 4.6 sec for the MILS and control groups, respectively (mean difference 7.1, CI 95% 5.0-9.3, P \ 0.0001). All patients who failed tracheal intubation in the MILS group were successfully intubated when MILS was removed. Conclusion In patients with otherwise normal airways, MILS increases the tracheal intubation failure rate at 30 sec and worsens laryngeal visualization during direct laryngoscopy. RésuméObjectif Bien que la stabilisation manuelle en ligne (SMEL) soit fre´quemment utilise´e pendant l'intubation endotrache´ale chez des patients pre´sentant une instabilited e la colonne cervicale connue ou suspecte´e, l'effet de la SMEL sur l'intubation orotrache´ale est tre`s peu documente´e. Cette e´tude a e´value´le taux d'e´chec de l'intubation trache´ale dans un intervalle de temps fixe avec une SMEL. Méthode Deux cents patients devant subir des chirurgies non urgentes ont e´te´randomise´s en deux groupes. Dans le groupe SMEL, la teˆte du patient a e´te´stabilise´e dans une

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“…There is ossification in the sott tissues anterior to C4, a large bridging osteophyte from C~, a smaller osteophyte connecting C6-7 and ossification in the posterior longitudinal ligament at multiple levels. FIGURE 2 The effect of the anterior osteophytes at C~_ 7 on the anatomy of the airway is detailed. There is anterior displacement of the larynx at the Cs.…”

Section: Case Reportmentioning

confidence: 99%

Diffuse idiopathic skeletal hyperostosis: an unusual cause of difficult intubation

Crosby

Grahovac

1993

Can J Anaesth

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Predicting Difficult Intubation

Cited by 110 publications

References 0 publications

Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: The laryngoscore

Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: The laryngoscore

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Diffuse idiopathic skeletal hyperostosis: an unusual cause of difficult intubation

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