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

Han, Yongzheng; Tian, Yun; Zhang, H.; Zhao, Yannan; Xu, Mao; Guo, Xiangyang

doi:10.1111/aas.13078

Cited by 28 publications

(42 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Clinically, there are many factors associated with difficulty of intubation during laryngoscopy, including head-neck trauma [ 2 ], airway abnormalities [ 3 ], gastroesophageal reflux disease [ 4 ], hard to open mouth [ 5 ], impaired cervical mobility [ 6 ], etc. The incidence of difficulty to undergo laryngoscopy and intubation ranges widely among different studies, and patients with cervical spondylosis have a higher incidence of difficult laryngoscopy (17.1%) [ 7 ] than those without cervical spondylosis (7.3%) [ 8 ]. This might in turn cause unexpected difficult airways in large proportion of patients, significantly increasing the morbidity and mortality rates [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

et al. 2020

View full text Add to dashboard Cite

Background We aimed to distinguish the preoperative radiological indicators to predict the application of assistant techniques during intubation for patients undergoing selective cervical surgery. Methods A total of 104 patients were enrolled in this study. According to whether intubation was successfully accomplished by simple Macintosh laryngoscopy, patients were divided into Macintosh laryngoscopy group (n = 78) and Assistant technique group (n = 26). We measured patients’ radiographical data via their preoperative X-ray and MRI images, and compared the differences between two groups. Binary logistic regression model was applied to distinguish the meaningful predictors. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. The highest Youden’s index corresponded to an optimal cut-off value. Results Ten variables exhibited significant statistical differences between two groups (P < 0.05). Based on logistic regression model, four further showed correlation with the application of assistant techniques, namely, perpendicular distance from hard palate to tip of upper incisor (X2), atlanto-occipital gap (X9), angle between a line passing through posterior-superior point of hard palate and the lowest point of the occipital bone and a line passing through the anterior-inferior point and the posterior-inferior point of the second cervical vertebral body (Angle E), and distance from skin to hyoid bone (MRI 7). Angle E owned the largest AUC (0.929), and its optimal cut-off value was 19.9° (sensitivity = 88.5%, specificity = 91.0%). the optimal cut-off value, sensitivity and specificity of other three variables were X2 (30.1 mm, 76.9, 76.9%), MRI7 (16.3 mm, 69.2, 87.2%), and X9 (7.3 mm, 73.1, 56.4%). Conclusions Four radiological variables possessed potential ability to predict the application of assistant intubation techniques. Anaesthesiologists are recommended to apply assistant techniques more positively once encountering the mentioned cut-off values.

show abstract

Section: Introductionmentioning

confidence: 99%

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In one such study, a large tongue area measured on preoperative computed tomography was associated with difficult laryngoscopy in acromegaly patients [16]. In another study conducted in patients with cervical spondylosis, a long mandibulohyoid distance and large angle of the anterior-inferior point of the upper incisor in the extended neck position were related to difficult laryngoscopy [17]. A short atlanto-occipital distance has also been reported to make laryngoscopy difficult [15].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have shown that body mass index (BMI), Mallampati score, and mouth opening predict difficult intubation with intubation devices such as direct laryngoscopes, videolaryngoscopes, and lightwands [11][12][13][14]. Regarding radiographic indices associated with difficult intubation, tongue area, atlanto-occipital gap, mandibulohyoid distance, and the angle of the anterior-inferior point of the upper incisor with the neck in extension are related to difficult laryngoscopy, while epiglottis length is associated with increased intubation time when using lightwands [15][16][17][18]. Despite the aforementioned advantages of videostylets, no clinical investigation has yet been performed to identify radiographic predictors of difficult intubation with videostylets.…”

Section: Introductionmentioning

confidence: 99%

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

Kim

Yoon

et al. 2020

BMC Anesthesiol

View full text Add to dashboard Cite

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.

show abstract

“…Inappropriate airway management may lead to airway injury, brain hypoxia, and even death. At present, the incidence rate of cervical spondylosis is increasing year by year, and these patients are often confronted with di cult laryngoscopy [2], with the incidence of di cult laryngoscopy to be 17.1% [3], far more than the incidence of 5.8% in the general population [4]. Considering that cervical spondylosis patients are more prone to appear unexpected di cult airway and even emergency airway, such as can't intubation can't ventilation situation, it is fundmentlly important to gure out the most valuable predictor of di cult laryngoscopy in patients with cervical spondylosis.…”

Section: Introductionmentioning

confidence: 99%

Preoperative X-ray C2C6AR is Applicable for Prediction of Difficult Laryngoscopy in Patients With Cervical Spondylosis

Zhou

Han

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Airway management is one of the most important techniques in clinical anesthesia practice, and inappropriate airway management is related with airway injury, brain hypoxia, and even death. The patients with cervical spondylosis are often confronted with difficult laryngoscopy and are more prone to appear unexpected difficult airway, so it is important to figure out the most valuable predictor of difficult laryngoscopy in these patients.Methods: We randomly enrolled 270 patients undergoing elective cervical spine surgery and analyzed the cervical mobility data in predicting difficult laryngoscopy. The preoperative X-ray radiological indicators were measured by an attending radiologist. Cormack–Lehane scales were assessed during intubation, and patients with a class III or IV view were assigned to the difficult laryngoscopy group.Results: Univariate analysis showed that the hyomental distance (HMD, the distance between the hyoid bone and the tip of the chin) and the hyomental distance ratio (HMDR, the ratio between HMD in the extension position and the one in the neutral position) might not be suitable indicators in patients with cervical spondylosis. Binary multivariate logistic regression (backward-Wald) analyses identified two independent risk factors from the cervical mobility indicators that correlated best as a predictor of difficult laryngoscopy: modified Mallampati test (MMT) and C2C6AR (the ratio of the angle between a line passing through the bottom of the second cervical vertebra and a line passing through the bottom of the sixth cervical vertebra in the extension position over the one in the neutral position). The odds ratio (OR) and 95% CI were 2.292(1.093-4.803) and 0.493 (0.306-0.793), respectively. C2C6AR exhibited the largest area under the curve (0.714; 95% CI 0.633–0.794).Conclusions: C2C6AR based on preoperative X-ray images may be the most accurate predictor of cervical mobility indicators for difficult laryngoscopy in patients with cervical spondylosis.Trial registration: The study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn; identifier: ChiCTR-ROC-16008598) on June 6, 2016.

show abstract

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

Cited by 28 publications

References 27 publications

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

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

Preoperative X-ray C2C6AR is Applicable for Prediction of Difficult Laryngoscopy in Patients With Cervical Spondylosis

Contact Info

Product

Resources

About