Abstract
BackgroundAirway management is one of the most important techniques in 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 who are more prone to appear difficult airway, so it is important to figure out valuable predictors of difficult laryngoscopy in these patients.MethodsWe 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.ResultsUnivariate 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 correlative 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 and 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).ConclusionsC2C6AR 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 registrationThe study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn; identifier: ChiCTR-ROC-16,008,598) on June 6, 2016.
Highlights
Airway management is one of the most important techniques in anesthesia practice and inappropriate airway management is related with airway injury, brain hypoxia, and even death
Three indicators were significantly different between the easy and difficult laryngoscopy groups: the Mallampati test (MMT) grade (P = 0.037), C2C6An and The ratio between C2C6Ae and C2C6An (C2C6AR)
BMI Body Mass Index; MMT modified Mallampati test; HMDn/e the distance between the hyoid bone and the tip of the chin in the neutral/ extension position; The ratio between HMDe and HMDn (HMDR) the ratio between HMDe and HMDn; C0C1Dn/e the distance between the occipital bone and the first cervical vertebra in the neutral/ extension position; The ratio between C0C1Dn and C0C1De (C0C1DR) the ratio between C0C1Dn and C0C1De; C1C2Dn/e the distance between first cervical vertebra and the second cervical vertebra in the neutral/ extension position; The ratio between C1C2Dn and C1C2De (C1C2DR) the ratio between C1C2Dn and C1C2De; C2C6An/e the angle between a line passing through the bottom of second cervical vertebra and a line passing through the bottom of sixth cervical vertebra in the neutral/ extension position; C2C6AR the ratio between C2C6Ae and C2C6An
Summary
Airway management is one of the most important techniques in 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 who are more prone to appear difficult airway, so it is important to figure out valuable predictors of difficult laryngoscopy in these patients. Inappropriate airway management may lead to airway injury, brain hypoxia and airway management failure is the primary cause of anesthesia-related deaths. Some of the patients are more prone to appear difficult laryngoscopy during tracheal intubation, which could even develop into the emergency airway, such as can’t intubation and can’t ventilation situation. There is still a lack of effective and specific evaluation methods for these patients, and it is fundamentally important to figure out the most valuable predictor of difficult laryngoscopy in patients with cervical spondylosis
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