The performance of neck circumference and other airway assessment tests for the prediction of difficult intubation in obese parturients undergoing cesarean delivery

Eiamcharoenwit, Jatuporn; Itthisompaiboon, Napon; Limpawattana, Panita; Suwanpratheep, Aticha; Siriussawakul, Arunotai

doi:10.1016/j.ijoa.2017.01.011

Cited by 23 publications

(23 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There were 218 test comparisons from 92 studies for difficult laryngoscopy, 72 comparisons from 50 studies for difficult intubation, 18 comparisons from seven studies for difficult facemask ventilation and two comparisons from two studies for failed intubation. Overall, the median (IQR [range]) number of participants per study, proportion of female participants, age and body mass index were 380 (200–662 [14–103,728]), 53% (44–64% [0–100%]), 45 (39–52 ) years and 27.3 (24.8–30.0 ) kg.m −2 , respectively. All studies except four performed airway management in operating theatres, two in the pre‐hospital setting and the others occurred in emergency rooms.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

et al. 2019

View full text Add to dashboard Cite

Although bedside screening tests are routinely used to identify people at high risk of having a difficult airway, their clinical utility is unclear. We estimated the diagnostic accuracy of commonly used bedside examination tests for assessing the airway in adult patients without apparent anatomical abnormalities scheduled to undergo general anaesthesia. We searched for studies that reported our pre-specified bedside index screening tests against a reference standard, published in any language, from date of inception to 16 December 2016, in seven bibliographic databases. We included 133 studies (127 cohort type and 6 case-control) involving 844,206 participants. Overall, their methodological quality (according to QUADAS-2, a standard tool for assessing quality of diagnostic accuracy studies) was moderate to high. Our pre-specified tests were: the Mallampati test (6 studies); modified Mallampati test (105 studies); Wilson risk score (6 studies); thyromental distance (52 studies); sternomental distance (18 studies); mouth opening test (34 studies); and the upper lip bite test (30 studies). Difficult facemask ventilation, difficult laryngoscopy, difficult intubation and failed intubation were the reference standards in seven, 92, 50 and two studies, respectively. Across all reference standards, we found all index tests had relatively low sensitivities, with high variability, but specificities were consistently and markedly higher than sensitivities. For difficult laryngoscopy, the sensitivity and specificity (95%CI) of the upper lip bite test were 0.67 (0.45-0.83) and 0.92 (0.86-0.95), respectively; upper lip bite test sensitivity (95%CI) was significantly higher than that for the mouth opening test (0.22, 0.13-0.33; p < 0.001). For difficult tracheal intubation, the modified Mallampati test had a significantly higher sensitivity (95%CI) at 0.51 (0.40-0.61) compared with mouth opening (0.27, 0.16-0.41; p < 0.001) and thyromental distance (0.24, 0.12-0.43; p < 0.001). Although the upper lip bite test showed the most favourable diagnostic test accuracy properties, none of the common bedside screening tests is well suited for detecting unanticipated difficult airways, as many of them are missed.

show abstract

Section: Resultsmentioning

confidence: 99%

“…We identified further studies from references of retrieved articles and used citation tracking in Science Citation Index. The search was updated in March 2018 but we have not incorporated the results from 27 studies in this review.…”

Section: Methodsmentioning

confidence: 99%

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

et al. 2019

View full text Add to dashboard Cite

show abstract

“…[ 18 ] Furthermore, they reported the neck circumference to sternomental distance in the sitting position of ≥2.7 and were optimal cutoff points to identify difficult intubation. [ 19 ] Our study showed that a neck circumference of ≥33.5 cm could be a sensitive predictor of difficult intubation in an obstetric population. This difference in the incidence of difficult intubation could be attributed to the use of cricoid pressure, differences in the patient populations studied, and a difference in the intubation scoring system used.…”

Section: Discussionmentioning

confidence: 80%

Does neck circumference help to predict difficult intubation in obstetric patients? A prospective observational study

2018

View full text Add to dashboard Cite

Background:Failed intubation in obstetrics remains the most common cause of death directly related to anesthesia. Neck circumference has been shown to be a predictor for difficult intubation in morbidly obese patients. The aim of this study was to determine an optimal cutoff point of neck circumference for prediction of difficult intubation in obstetric patients.Methods:Ninety-four parturients scheduled for cesarean section under general anesthesia were included in the study. Preoperative airway assessment and neck circumference were measured. Difficult intubation was the primary outcome according to the intubation difficulty scale (IDS), intubation reported difficult if the IDS score was ≥5.Results:Univariate analysis showed that Mallampati score and neck circumference were positive predictors for difficult intubation (P = 0.005 and P = 0.011, respectively). Mouth opening, thyromental distance, sternomental distance, and the hyomental distance ratio were not useful predictors (P = 0.68, P = 0.87, P = 0.48, and P = 0.27, respectively). Logistic regression for the Mallampati score and neck circumference negative results as independent predictors of difficult intubation in obstetric (P = 0.53). Sensitivity analysis showed that neck circumference of 33.5 cm is the cutoff point to detect difficult intubation with 100% sensitivity (95% confidence interval [CI]: 69.2–100) and 50% specificity (95% CI: 38.9–61.1). The area under the curve for neck circumference was 0.746 (95% CI: 0.646–0.830) with a positive predictive value of 19.2 (95% CI: 9.6–32.5), a negative predicative value of 100 (95% CI: 91.6–100), and a P < 0.0001.Conclusions:In obstetric patients, a neck circumference ≥33.5 cm is a sensitive predictor for difficult intubation.

show abstract

“…A number of factors may be associated with frequent occurrence of SDB in preeclampsia women. First, the physiological and anatomical changes during pregnancy which make a gravid woman more prone to sleep-disordered breathing [22][23][24] are more pronounced in preeclampsia due to alterations in the upper airway patency which may be related to the fluid shifts from the lower limbs to the neck area. This may explain the increased occurrence of SDB in preeclamptic women even after controlling for BMI which is one of the major risk factors for the development of SDB.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Sleep-Disordered Breathing on Severity of Pregnancy-Induced Hypertension and Feto-Maternal Outcomes

Suri

Arora

et al. 2018

J Obstet Gynecol India

View full text Add to dashboard Cite

show abstract

The performance of neck circumference and other airway assessment tests for the prediction of difficult intubation in obese parturients undergoing cesarean delivery

Cited by 23 publications

References 21 publications

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

Does neck circumference help to predict difficult intubation in obstetric patients? A prospective observational study

The Impact of Sleep-Disordered Breathing on Severity of Pregnancy-Induced Hypertension and Feto-Maternal Outcomes

Contact Info

Product

Resources

About