Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index

Abstract

Several clinical multifactorial indexes have been described for predicting difficult laryngoscopy or intubation, or both, mostly in general surgery, and less frequently in ENT surgery. The objective of this study was to develop and validate a single clinical index for prediction of difficulty in tracheal intubation in both ENT and general surgery. We studied a population of 1200 consecutive ENT and general surgical patients. Clinical criteria were tested using univariate and multivariate analysis. Difficult intubation was defined as requiring unusual techniques. Logistic regression identified seven criteria as independent predictors of difficult tracheal intubation; previous history of difficult intubation; pathologies associated with difficult intubation; clinical symptoms of pathological airway; inter-incisor gap and mandible luxation; thyromental distance; head and neck movement; and Mallampati's modified test. Point values were assigned to each of these factors in proportion to regression coefficients representing the relative weight of each predictive intubation difficulty factor, the sum comprising the score. The best predictive threshold was chosen using a receiver operating characteristic curve. We then prospectively studied and validated the score in a population of 1090 consecutive ENT and general surgery patients. The sensitivity and specificity of the predictions were 94% and 96% in general surgery, 90% and 93% in non-cancer ENT surgery, and 92% and 66% in ENT cancer surgery, respectively.

Evaluation of an improved scoring system for the grading of direct laryngoscopy

“…Whilst it might be argued that the only laryngoscopic views which truly make intubation difficult are Cormack and Lehane grades 3 or 4, or possibly even grade 4 alone, we would argue that although intubation in these situations may be more difficult, some extra maneouvre or equipment is still required in a proportion of grade 1 and 2 laryngoscopies (6.0% in our study overall) and it is this fact which needs to be recorded. Authors of a recent evaluation of a multivariate risk index for predicting difficult intubation recognised this fact and defined difficulty as the requirement for intubation aids, resulting in an overall incidence of 3.8% in general surgical patients compared with 7.1% in our study [10].…”

S1 guidelines on airway management

“…Additional test methods, which likewise are less sensitive, comprise the upper lip bite test [13], mobility of the cervical spine, the palm print test [14,15] and the Wilson risk score [16,17]. The multifactorial risk index of Arné et al incorporates seven different criteria [18] so that different predictors are included. .…”

La sédation au propofol permet l’intubation difficile vigile avec le masque laryngé FastrachTM

“…1,2 Elle est recherchée lors de la consultation pré anesthésique, en utilisant le plus souvent un score multifactoriel. 3 Le score développé par Arné et coll. 3 est un score simple et utilisable en pratique clinique.…”

“…3 Le score développé par Arné et coll. 3 est un score simple et utilisable en pratique clinique. Un score inférieur à 11 permet d'exclure une difficulté d'intubation avec une bonne fiabilité.…”

“…Un score inférieur à 11 permet d'exclure une difficulté d'intubation avec une bonne fiabilité. 3 Lorsque l'intubation difficile est prévisible, la technique recommandée actuellement par la conférence d'experts de la Société Française d'Anesthésie et de Réanimation de 1996 (SFAR) est l'intubation vigile sous fibroscope. 4 L'intubation vigile sous masque laryngé Fastrach™ (MLF ; Fastrach, Laryngeal Mask Company, Henley-on-Thames, UK) peut être une technique alternative.…”