Difficult Tracheal Intubation Research Articles

A data review of airway management in patients with oral cavity or oropharyngeal cancer: a single-institution experience

BackgroundOral cavity and oropharyngeal cancer impose significant threat to airway management. Head and neck radiotherapy (HNRT) may further increase the difficulty of tracheal intubation. We hypothesized that a history of HNRT would be associated with a high rate of difficult tracheal intubation.MethodsAdult patients with a history of HNRT were identified. Non-HNRT controls were case-matched by age, sex and body mass index. The tracheal intubation status between the two patient groups (treated vs. untreated with HNRT) was compared. The t test was used to evaluate differences in continuous variables between the 2 groups. Fisher’s exact test or a chi-square test was used to test for associations between radiation status and patient characteristics that may be associated with difficult tracheal intubation. Odds ratio and its confidence interval were used to assess the effect of radiation status on intubation status.ResultsThe final cohort of 472 matched patients in age, sex and body mass index consisted of 236 patients who had HNRT before surgery and 236 who had upfront surgery without HNRT. The percentage of patients who had restricted neck range of motion in the HNRT group was significantly higher than in the control group (22.3% vs. 11.0%; p = 0.001). The proportion of patients with trismus (p = 0.11) or difficult tracheal intubation (p = 0.73) did not differ significantly between the 2 groups. 12.7% patients in the study had difficult tracheal intubation. Patients who had mallampati scores of 3 or 4 had significantly higher rate of difficult tracheal intubation than did patients with mallampati scores of 1 or 2 (17.8% vs. 8.7%; p = 0.004). Multivariate logistic regression model showed no difference between HNRT and intubation status after adjusting neck range of motion and mallampati score (OR = 0.91, 95% CI: 0.510 to1.612).ConclusionsPrevious treatment with HNRT was not associated with additional risk of difficult tracheal intubation. Mallampati score may be a sensitive measurement for difficult tracheal intubation in this patient population.

Predictive Values of Preoperative Tests for Difficult Laryngoscopy and Intubation in Adult Patients at Tikur Anbessa Specialized Hospital.

Introduction The significance of difficult or failed tracheal intubation following induction is a well-recognized cause of morbidity and mortality in anesthetic practice. Nevertheless, the need to predict potentially difficult tracheal intubation has received a little attention. During routine anesthesia, the incidence of difficult tracheal intubation has been estimated at 1.5%–8% of general anesthetics. Difficulties in intubation have been associated with serious complications, such as brain damage or death, particularly when failed intubation has occurred. Occasionally, in a patient with a difficult airway, the anesthetist is faced with the situation where mask ventilation proves difficult or impossible. This is one of the most critical emergencies that may be faced in the practice of anesthesia. If the anesthetist can predict which patients are likely to prove difficult to intubate, he/she may reduce the risks of anesthesia considerably. In Ethiopia, there are no data on the magnitude of difficult laryngoscopic tracheal intubation and no standard guidelines for preoperative tests. The main concern of this study was to provide information on the magnitude of difficult laryngoscopic intubation and to determine valuable preoperative tests to predict difficult laryngoscopy and intubation in patients with apparently normal airways which can help anesthetists to improve preoperative airway assessment and contribute to decrease anesthesia-related morbidity and mortality. Objective The main objective of this study was to assess the magnitude and predictive values of preoperative tests for difficult laryngoscopy and intubation, among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation in Tikur Anbessa Hospital from February 1 to March 30, 2016. Study Design A facility-based cross-sectional study design was used. Result In this study, we found the magnitude of difficult laryngoscopy and intubation as 13.6% and 5%, respectively. 33.3% of patients with difficult laryngoscopy were found to be difficult for intubation. Mallampati test, interincisor distance, and thyromental distance were identified to be good preoperative tests to predict difficult laryngoscopic intubation when used in combination. Recommendation We recommend anesthesia professionals to use combination of MMC/TMD/IID for their routine preoperative airway assessment.

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

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.

Challenging the Traditional Definition of a Difficult Intubation: What Is Difficult?

Challenging the Traditional Definition of a Difficult Intubation: What Is Difficult?

Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: a report from the National Emergency Airway Registry for Neonates

ObjectiveTo determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU).DesignRetrospective review of prospectively collected data on intubations performed in the NICU...

Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans

BackgroundSeveral methods have been used to predict difficult tracheal intubation. Among recently suggested methods, the upper lip bite test (ULBT) could serve as a good predictor. Soft tissue and skeletal hard tissue profiles are affected by many factors including ethnicity. We aimed to assess the clinical utility of the ULBT in Koreans while considering ethnic differences.MethodsThree-hundred-forty-four Korean patients undergoing general anesthesia with orotracheal intubation were included. Preoperatively, we recorded the patient’s Modified Mallampati (MMT) classification, ULBT ratings, and the Cormack–Lehane grade.ResultsThe area under the receiver operating characteristic (ROC) curve (AUC) was lower for the ULBT than the MMT (95% confidence interval: 0.0697–0.191, p < 0.0001). The ULBT showed high accuracy (73.83%) and specificity (98.04%). On the other hand, the ULBT showed significantly lower sensitivity (4.49%). Only nine of 344 Korean patients could not bite their upper lip; among them, only three presented a difficult laryngoscopic view.ConclusionsOne factor related to the low sensitivity is the low incidence of a grade III ULBT in Koreans. In Asians, the scarcity of a grade III ULBT is explainable as a result of anteriorly displaced temporomandibular joints and redundant lip soft tissues. Despite its high specificity, the low sensitivity and AUC of the ULBT mean that the test results should be interpreted cautiously in Koreans. Ethnic differences should be considered when evaluating parameters related to soft tissues such as the ULBT.Trial registrationClinicalTrials.gov Identifier: NCT01908218, Date of registration JUL 2013.

Hemodynamic Response to Orotracheal Intubation: Comparison between Macintosh, McCoy, and C-MAC Video Laryngoscope.

Background:The most commonly used devices for direct visualization of the larynx and tracheal intubation are Macintosh and McCoy laryngoscopes. C-MAC video laryngoscope, based on the principles of indirect laryngoscopy, has been introduced into clinical practice in recent years. Video laryngoscope may be useful in difficult tracheal intubation situations.Aim:We aimed at comparing the McCoy and C-MAC video laryngoscope with conventional Macintosh laryngoscope for hemodynamic responses of orotracheal intubation among adults receiving general anesthesia for elective surgeries.Settings and Design:This was a hospital-based randomized, double-blind, comparison, done between June 2015 and October 2016 after permission of institutional ethical committee.Materials and Methods:One hundred and fifty patients with normal airways undergoing elective general anesthesia were randomly allocated to undergo intubation using either Macintosh (Group A), McCoy (Group B), or C-MAC video laryngoscope (Group C). Hemodynamic changes associated with intubation were recorded immediately before and after laryngoscopy and intubation, every minute for 5 min and at 10 min after intubation by an independent observer. The time taken to perform endotracheal intubation and Cormack and Lehane score were also noted in all three groups.Statistical Analysis:Data were compiled, and statistical analysis was performed using SPSS 17.0 version.Results:Hemodynamic response after intubation was least in Group B (McCoy) as compared to Group A (Macintosh) and Group C (C-Mac) (P = 0.001). Ninety-two percentage patients were in Cormack and Lehane score Class I in Group C in comparison to 52% in Group A and 48% in Group B (P = 0.000). Time for intubation taken in Group A, Group B, and Group C was 15.53 ± 1.53 min, 18.65 ± 0.44 min, and 22.82 ± 1.323 min, respectively (P = 0.000).Conclusion:The McCoy laryngoscope provided better attenuation of hemodynamic responses to laryngoscopy and intubation than the Macintosh and C-Mac video laryngoscope whereas more appearance of Cormack and Lehane score Class I was seen with the C-MAC video laryngoscope. Furthermore, the time taken to perform endotracheal intubation was the longest with the C-MAC video laryngoscope.

Comparison of upper-lip bite test with other four predictors for predicting difficulty in intubation

Background: Unanticipated difficult tracheal intubation remains a primary concern of anaesthesiologists. The aim of the present study was to compare upper-lip bite test (ULBT) with other four predictors namely modified Mallampati test (MMT), thyromental distance (TMD), sternomental distance (SMD) and interincisor distance (IID) for predicting difficulty in intubation. Methods: Airway assessment indices were evaluated and compared in 60 American Society of Anesthesiologists physical status Grade I and II patients undergoing general anaesthesia at a tertiary care teaching hospital in South India. The cut-off points for defining the difficult intubation (DI) were as follows: for ULBT, Class III; MMT, Classes 3 and 4; TMD Results: DI was observed in 26.7% of all patients studied. Sensitivity, specificity, PPV, NPV and accuracy for ULBT were 6.3%, 97.7%, 50%, 74.1% and 73.3%, respectively, whereas those for MMT were 25%, 86.4%, 40%, 76% and 70%, respectively. MMT showed 50% sensitivity and 84.5% specificity in assessing difficulty in intubation when compared with ULBT, whereas all the other methods have shown 0% sensitivity. MMT is a better predictor of difficulty in intubation when compared with ULBT due to its high sensitivity, better specificity, PPV and accuracy. Conclusions: No single airway predictor was accurate in predicting DI. A combination of at least two or more airway predictors has to be analysed to arrive at a near-ideal difficult airway prediction.

Laryngoscopic view in a child with previous difficult tracheal intubation and a history of growth hormone therapy.

Laryngoscopic view in a child with previous difficult tracheal intubation and a history of growth hormone therapy.

Incidence and risk factors of hypoxaemia after preoxygenation at induction of anaesthesia

The incidence of hypoxaemia related to airway management is still a matter of concern. Our aim was to determine the factors that contribute to hypoxaemia during induction of anaesthesia after a standardised preoxygenation procedure. The study was a multicentre and prospective observational trial. It evaluated the incidence of hypoxaemia at induction of anaesthesia in adult patients. The primary endpoint was the incidence of hypoxaemia defined as pulse oximetry of arterial oxyhaemoglobin saturation (SpO2) <95%. Of 2398 patients, hypoxaemia was observed in 158 (6.6%). We identified five preoperative independent risk factors: chronic obstructive pulmonary disease, hypertension, anticipated difficult mask ventilation and difficult tracheal intubation, and emergency surgery. There were also three pre-induction independent risk factors: difficult preoxygenation, difficult mask ventilation, and difficult tracheal intubation. We found a high negative predictive value of preoperative risk factors for difficult mask ventilation of 0.96 (0.95-0.96), and for difficult tracheal intubation (0.95 [0.94-0.96]). A total of 723 patients (30%) experienced difficult preoxygenation (FeO2 <90% at the end of preoxygenation). Male sex, chronic obstructive pulmonary disease, hypertension, emergency surgery, and predictable difficult mask ventilation were independent patient risk factors for difficult preoxygenation. Difficult mask ventilation and difficult tracheal intubation are risk factors for hypoxaemia at induction of general anaesthesia. Difficult preoxygenation was observed in 30% of patients and was also identified as a risk factor for hypoxaemia. This suggests that techniques improving preoxygenation should be implemented in daily practice.

Evaluation of the Airtraq video laryngoscope as a rescue device after difficult direct laryngoscopy

Abstract Background and objectives Unexpected difficult tracheal intubation and failure to intubate are among the leading causes of anaesthesia-related morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Airtraq video laryngoscope for tracheal intubation after difficult direct laryngoscopy. Methods 75 patients undergoing elective surgery under general anaesthesia and whose direct laryngoscopy by a senior anaesthesiologist exhibited Cormack–Lehane grade 2b, 3 or 4 were enrolled. Results The Glottic view was improved in all patients when using the Airtraq video laryngoscope, compared with Macintosh laryngoscope. The view was improved by 2 degrees in 17.3% of the cases, by three in 60% and by four grades in 22.7% (p Conclusions Tracheal intubation using the Airtraq was effective, simple and safe in patients with difficult laryngoscopy. These results confirm that the Airtraq is a reliable video laryngoscope as a rescue device in cases of difficult laryngeal view with direct laryngoscopy.

Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia

The use of cricoid pressure (Sellick maneuver) during rapid sequence induction (RSI) of anesthesia remains controversial in the absence of a large randomized trial. To test the hypothesis that the incidence of pulmonary aspiration is not increased when cricoid pressure is not performed. Randomized, double-blind, noninferiority trial conducted in 10 academic centers. Patients undergoing anesthesia with RSI were enrolled from February 2014 until February 2017 and followed up for 28 days or until hospital discharge (last follow-up, February 8, 2017). Patients were assigned to a cricoid pressure (Sellick group) or a sham procedure group. Primary end point was the incidence of pulmonary aspiration (at the glottis level during laryngoscopy or by tracheal aspiration after intubation). It was hypothesized that the sham procedure would not be inferior to the cricoid pressure. The secondary end points were related to pulmonary aspiration, difficult tracheal intubation, and traumatic complications owing to the tracheal intubation or cricoid pressure. Of 3472 patients randomized, mean (SD) age was 51 (19) years and 1777 (51%) were men. The primary end point, pulmonary aspiration, occurred in 10 patients (0.6%) in the Sellick group and in 9 patients (0.5%) in the sham group. The upper limit of the 1-sided 95% CI of relative risk was 2.00, exceeding 1.50, failing to demonstrate noninferiority (P = .14). The risk difference was -0.06% (2-sided 95% CI, -0.57 to 0.42) in the intent-to-treat population and -0.06% (2-sided 95% CI, -0.56 to 0.43) in the per protocol population. Secondary end points were not significantly different among the 2 groups (pneumonia, length of stay, and mortality), although the comparison of the Cormack and Lehane grade (Grades 3 and 4, 10% vs 5%; P <.001) and the longer intubation time (Intubation time >30 seconds, 47% vs 40%; P <.001) suggest an increased difficulty of tracheal intubation in the Sellick group. This large randomized clinical trial performed in patients undergoing anesthesia with RSI failed to demonstrate the noninferiority of the sham procedure in preventing pulmonary aspiration. Further studies are required in pregnant women and outside the operating room. ClinicalTrials.gov Identifier: NCT02080754.

Evaluación del videolaringoscopio Airtraq como dispositivo de rescate tras laringoscopia directa difícil

Background and objectivesUnexpected difficult tracheal intubation and failure to intubate are among the leading causes of anesthesia-related morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Airtraq video laryngoscope for tracheal intubation after difficult direct laryngoscopy. Methods75 patients undergoing elective surgery under general anesthesia and whose direct laryngoscopy by a senior anesthesiologist exhibited Cormack-Lehane grade 2b, 3 or 4 were enrolled. ResultsThe Glottic view was improved in all patients when using the Airtraq video laryngoscope, compared with Macintosh laryngoscope. The view was improved by 2 degrees in 17.3% of the cases, by three in 60% and by four grades in 22.7% (P<0.0001). The success rate for intubation was 100% with the Airtraq. Fifty-six patients (74.7%) required a single attempt, sixteen (21.3%) two attempts and three (4%) a third attempt. Intubation difficulty scale indicated that tracheal intubation was performed easily in most cases There were no critical events. ConclusionsTracheal intubation using the Airtraq was effective, simple and safe in patients with difficult laryngoscopy. These results confirm that the Airtraq is a reliable video laryngoscope as a rescue device in cases of difficult laryngeal view with direct laryngoscopy.

The influence of bilateral hyperplasia of the coronoid process of the mandible for difficult tracheal intubation

Bilateral hyperplasia of the coronoid process of the mandible is rare condition. Commonly there is only one mechanical symptom, limiting mouth opening. The aim of this article is to introduct medical history of a 38 year-old female with bilateral hyperplasia of the coronoid process of the mandible confirmed by examination and RTG diagnostic. There is also the question of difficulties during intubation due to bilateral hyperplasia in this case.

Diagnostic point-of-care ultrasound: applications in obstetric anaesthetic management.

Complications during pregnancy are not frequent, but may occur abruptly. Point-of-care ultrasound is a non-invasive, non-ionising diagnostic tool that is available at the bed-side when complications occur. This review covers the use of ultrasound in various clinical situations. Gastric ultrasound can identify stomach contents that put the woman at risk for pulmonary aspiration. In the future, this tool will probably be used routinely before induction of anaesthesia to determine the presence of stomach contents above a particular risk threshold. Difficult tracheal intubation, and the potential for 'can't intubate, can't oxygenate', is more frequent in pregnant women. Point-of-care ultrasound of the airway allows accurate identification of the cricothyroid membrane, permitting rapid and safer establishment of front-of-neck airway access. Combined cardiac and lung ultrasound candetermine the potential risk:benefit of fluid administration in the pregnant patient. Such prediction is of critical importance, given the tendency of pregnant women to develop pulmonary oedema. Combined echocardiography and lung ultrasound can be combined with ultrasound of the leg veins to differentiate between the various causes of acute respiratory failure, and guide treatment in this situation. Finally, as shown in the general population, multi-organ point-of-care ultrasound allows early diagnosis of the main causes of circulatory failure and cardiac arrest at the bed-side. As the importance of point-of-care ultrasound in critical patients is increasingly recognised, it is emerging as an important tool in the therapeutic armoury of obstetric anaesthetists.

Predictors of difficult airway in a Chinese surgical population: the gender effect.

Compared with men, women often have a shorter interincisor distance and a shorter thyromental distance but are less likely to have difficult airway. The hypothesis is that the prediction criteria of difficult airway differ between men and women. The aim of this study was to investigate differences in the prediction criteria of anatomic predictors for difficult airways in men and women. We enrolled adult patients who underwent general anesthesia and tracheal intubation. The interincisor distance, thyromental distance, modified Mallampati test results, upper lip bite test results, and tongue thickness of each patient were evaluated prior to the initiation of anesthesia. The primary outcome was difficult tracheal intubation. Receiver operating characteristic (ROC) curve analysis and Youden's index were used to determine the criteria for predictors in men and women. In total, 1059 men and 1195 women were examined. Compared with women, men had a higher incidence of difficult tracheal intubation (P<0.001). The cut-off values for predicting difficult tracheal intubation of the interincisor distance, thyromental distance, modified Mallampati test results, upper lip bite test results, and tongue thickness determined by Youden's index were ≤38 mm, ≤70 mm, >3, >2, and >62 mm, respectively, for men, and ≤33 mm, ≤65 mm, >2, >1, and >60 mm, respectively, for women. The optimal cut-off values of predictors of difficult airway differ between males and females.

The association of body mass index with difficult tracheal intubation management by direct laryngoscopy: a meta-analysis

BackgroundObesity is a serious disorder and may bring about many difficulties of perioperative management. A systematic review was conducted to assess the association between obesity and difficult intubation.MethodsWe searched electronic databases for related reviews and references of meta-analyses on August 14, 2017. The databases of PubMed, Embase, and the Cochrane controlled trials register were searched compared obese with non-obese patients in which difficult intubation rate of the adult population were retrieved. Patients with a BMI ≥ 30 kg·m− 2 were considered obese. The primary outcome was difficult tracheal intubation; secondary outcomes were the rates of difficult laryngoscopy and Mallampati score ≥ 3. This review included papers published from 1998 to 2015.ResultsThis review included 204,303 participants in 16 studies. There was a statistically significant association between obesity and risk of difficult tracheal intubation (pooled RR = 2.04, 95% CI: 1.16–3.59, p = 0.01; I2 = 71%, p = 0.008, Power = 1.0). It also showed significantly association between obesity and risk of difficult laryngoscopy (pooled RR = 1.54, 95% CI: 1.25–1.89, p < 0.0001; I2 = 45%, p = 0.07, Power = 1.0), obesity and risk of Mallampati score ≥ 3 (pooled RR = 1.83, 95% CI: 1.24–2.69, p = 0.002; I2 = 81%, p < 0.00001, Power = 0.93). However, there were no association of obesity and risks of difficult intubation compared with non-obesity in the cohort studies (pooled RR = 3.41, 95% CI: 0.88–13.23, p = 0.08; I2 = 50%, p = 0.14) and the elective tracheal intubation (pooled RR = 2.31, 95% CI: 0.76–6.99, p = 0.14; I2 = 73%, p = 0.01), no associated with an increased risk of difficult laryngoscopy in the sniffing position (pooled RR = 2.00, 95% CI: 0.97–4.15, p = 0.06; I2 = 67%, p = 0.03).ConclusionObesity was associated with an increased risk of difficult intubation, difficult laryngoscopy and Mallampati score ≥ 3 in adults patients undergoing general surgical procedures. However, there were no association of obesity and risks of difficult intubation compared with non-obesity in the cohort studies and the elective tracheal intubation, no associated with an increased risk of difficult laryngoscopy in the sniffing position. Future analyses should explore the association of BMI and difficult airway.

Identification of Patients With the Risk for Difficult Tracheal Intubation in the Intensive Care Unit

Background: Aims: Identification of patients at risk for difficult visualization of the larynx (DVL) using Hyomental distance ratio (HMDR) in adopting an alternative strategy for intubation at intensive care unit. Settings and Design: Haemodynamicaly stable unconscious patients with GCS &lt;8 admitted in intensive care unit requiring intubation. &nbsp;Subjects and Methods: A scale was put on to the surface on the skin near to&nbsp; hyoid bone, and distance from point near mentum to&nbsp; hyoid bone measured and was taken as the Hyo-mental distance (neutral position) and measurement&nbsp; taken by extension method and ratio&nbsp; calculated. After intravenous induction followed by paralysis,vocal cords were visualised&nbsp; and assessed with Cormach and Lehane method (C&amp;L) classification. Statistical analysis: Done using students ‘t’ test and chi-square test. Results: The highest sensitivity 26.30% observed in predicting DVL was with HMDR (26.30%). Conclusion: HMDR is a good and reliable predictor of DVL to certain extent , because of its higher specificity and negative predictive value.

USE OF PREDICTIVE EL-GANZOURI SCORE IN EVALUATION OF DIFFICULT AIRWAY IN OBESE PATIENTS

The frequency of difficult laryngoscopy and tracheal intubation in obese patients is higher compared to non-obese patients. Therefore it is important to perform an adequate assessment of airway before surgery with general anesthesia and tracheal intubation in such patients. This retrospective study evaluated the predictive value of El-Ganzouri score in the patients with body weight index exceeding 30 kg/sq. m. Subjects and methods. 116 patients were enrolled into the study, general anesthesia with tracheal intubation was planned in all those patients. The airway of all patients was assessed by El-Ganzouri score prior to surgery. Regardless of the number of scores in a patient, a video laryngoscope was always used, however by the first intubation attempt it was used as a regular one. Results. The score sensitivity made 0.81, specificity – 0.66, positive predictability – 0.4, negative predictability – 0.93. The area under ROC-curve made 0.82. Conclusions. We recommend El-Ganzouri score for evaluation of airway in the patients with BMI exceeding 30 kg/sq. m. since it possesses good modeling properties (AUC = 0.85) and allows selecting the safest way of intubation.

Airway physical examination tests for detection of difficult airway management in apparently normal adult patients.

Airway physical examination tests for detection of difficult airway management in apparently normal adult patients.