Predicting Difficult Intubation

Bellhouse, C. P.; Doré, C.F.

doi:10.1093/bja/62.4.469

Cited by 11 publications

(4 citation statements)

References 7 publications

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“…Many factors contribute to difficult laryngoscopy, including limited mouth-opening, short mandibular distance and limited cervical spine movement. Though previous studies [2][3][4][5][6][7][8][9][10] focusing on these contributory or associated factors have added significantly to this field, a reliable assessment has remained elusive 9 . Difficulties in airway assessment are compounded by inter-observer variability 11 , inaccuracies in measured airway variables at the bedside, and the plethora of airway devices, each having a different impact on the airway.…”

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confidence: 99%

Airway Assessment Based on a three Column Model of Direct Laryngoscopy

Greenland

2010

Anaesth Intensive Care

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Airway assessment has remained a problematic area, largely due to the low sensitivities, specificities and/or positive predictive values of most bedside tests. In this paper, a structured overview of the common preoperative airway assessment tests is presented, based on a model for direct laryngoscopy that has been previously described. This model is composed of three columns: anterior, middle and posterior. The anterior column tests are classified into the assessment of volume and compliance of the submandibular space, the range of movement of the temporomandibular joints and the flexibility of the stylohyoid ligament. Reductions in volume of the anterior column may be absolute or relative. An absolute reduction may occur with shortening of either the incisor-hyoid distance, the temporomandibular joint-incisor distance or the temporomandibular joint-temporomandibular joint distance. A relative reduction may be seen with either prominent upper front incisors or large tongues. Testing of the middle column includes a history and physical examination of the upper respiratory system, imaging of the airway (such as X-ray, computed tomography scans and/or magnetic resonance imaging scans) and nasopharyngoscopy. The posterior column may be assessed by the range of movement of the neck, especially the range of extension of the occipito-atlanto-axial complex. By integrating common tests of the anterior, middle and posterior columns within this three-column model, the practitioner may be better positioned to understand the complexity of direct laryngoscopy in both normal and difficult airway scenarios.

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confidence: 99%

Airway Assessment Based on a three Column Model of Direct Laryngoscopy

Greenland

2010

Anaesth Intensive Care

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“…This in turn is in conflict with studies clearly indicating that during routine laryngoscopy performed by experienced anesthetists the maxillary incisors are exposed to considerable forces as the majority of anesthetists use those teeth as a fulcrum point of leverage as the most efficient way to bring the glottis into view (1). Although the Macintosh laryngoscope blade can negotiate most tight oro‐pharyngeal corners because of it's total curve of almost 30 degrees (20) during laryngoscopy the vertical component often contacts the upper frontal teeth. In patients with limited motion of the mandible this results in limited rotation of the distal end of the blade.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of dental injury following endotracheal intubation using the Periotest^® technique

Hoffmann

Westendorff

Reinert

2005

Dental Traumatology

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The hazards of damage to teeth and their periodontal attachment during tracheal intubation are well known. Dental trauma represents the commonest single reason for complaints against anesthesiologists. In order to predict the possible risk of perianesthetic iatrogenic tooth luxation we evaluated the use of a measuring method (Periotest technique), being well established for the diagnosis of periodontal disease. In 120 patients undergoing elective surgery, we compared the amount of tooth mobility before and after general anesthesia to different scores assessing the difficulty of tracheal intubation. Furthermore, the level of work experience of the intubating anesthetist was compared with the degree of postoperative tooth mobility. Changes of periodontal attachment could not be detected by the Periotest technique. The Periotest technique does not seem to have the ability to detect early periodontal changes associated with endotracheal intubation.

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“…The point is that anaesthetists use one of the currently available methods for predicting difficult intubation [10], not that there may be little difference between the results of the published methods of predicting difficulty.…”

Section: Saw a Riyadh Armed Forces Hospitalmentioning

confidence: 99%