Incidence Of Difficulties Research Articles

Impact of COVID-19 on Breastfeeding among SARS-CoV-2 Infected Pregnant Women: A Single Centre Survey Study.

Background: Although current guidelines recommend that mothers with suspected or confirmed SARS-CoV-2 infection should be encouraged to initiate and continue breastfeeding, up-to-date literature shows conflicting data regarding breastfeeding experiences in infected women. This survey aimed to report on the psychological impact of SARS-CoV-2 infection on breastfeeding practice and medical counselling in a single tertiary center in Southern Italy. Methods: One-hundred breastfeeding women with SARS-CoV-2 infection at delivery were given an anonymous questionnaire regarding breastfeeding and women’s perception of the impact of COVID-19 on breastfeeding. Results: 75% of women reported they had difficulty breastfeeding; among them, 66 (66%) declared that separation from their babies after delivery affected their ability to breastfeed. Incidence of reported difficulties in breastfeeding was higher in women who underwent caesarean section compared to women with vaginal delivery (56/65, 86.2% vs. 19/35, 54.3%, χ2 = 12.322, p < 0.001) and in women with a hospital stay of more than 5 days (48/57, 84.2% vs. 23/37, 62.2%, χ2 = 5.902, p = 0.015). Furthermore, the incidence of difficulties in breastfeeding was higher in women who subsequently decided to use exclusively infant formula compared to women who mixed maternal milk with infant formula and women who breastfed exclusively with maternal milk (48/49, 98% vs. 20/25, 80% vs. 7/26, 26.9%, χ2 = 46.160, p < 0.001). Conclusions: Our survey highlights the importance of healthcare support and information on hygiene practices to decrease the perceived stress related to breastfeeding for infected mothers under restrictions, especially in women undergoing cesarean section and with a long hospital stay.

Closure versus Non-closure Buccal Mucosal Graft Site for Lowering Post-operative Morbidity in Patient with Urethral Stricture Underwent Urethroplasty: A Systematic Review and Meta-analysis

BACKGROUND: Buccal mucosal graft (BMG) has been a widely known technique for anterior urethral reconstruction; however, the studies regarding its morbidity are still limited. AIM: The purpose of this study is to compare postoperative morbidity outcome between closure versus non-closure BMG harvest site in patients with urethral stricture underwent urethroplasty. METHODS: A systematic review and meta-analysis of randomized controlled trials and prospective cohort studies was conducted. Literature searching was done through electronic databases, including PubMed, Science Direct, EBSCO, ProQuest, and Google Scholar. The inclusion criteria were men diagnosed with urethral stricture and underwent urethroplasty procedure. The participants were two groups of patients divided based on whether their BMG harvest site was closed or left open. No exclusion criteria applied to the types of participants. The statistical analysis was performed using Review Manager version 5.3 software. Cochrane risk-of-bias tool was used to evaluate the quality of the study. RESULTS: We analyzed five studies qualitatively and three studies quantitatively. There was no significant difference between the closure and non-closure BMG in pooled standard mean difference (SMD) on the oral pain in day-1 and month-6 post-operation. However, pain score in day-1 post-operation was slightly higher in the closure group (SMD 0.49, 95% CI –0.31, 1.30). The incidence of perioral numbness in day-1 post-operation was significantly higher in the closure group (RR 1.48, 95% CI 1.04, 2.10, p &lt; 0.05). The incidence of difficulty in opening mouth in day-1 post-operation also significantly higher in closure group (RR 1.48, 95% CI 1.14, 1.91, p = 0.003). There was no significant morbidity difference between two groups reported in five studies included after 6 months post-operation. CONCLUSION: There was no significant difference between closure and non-closure of BMG in the post-operative pain morbidity. However, the incidence of the early perioral numbness and difficulty in mouth opening was significantly lower in non-closure group.

Characteristics of the swallowing of cortical stroke survivors with dysphagia and cognitive impairment

Objective To identify the pathophysiological characteristics of cortical stroke survivors′ swallowing. Methods Sixty cortical stroke survivors with dysphagia and cognitive impairment were enrolled into the observation group, while another 16 with dysphagia but without cognitive impairment formed the unimpaired control group and 16 healthy counterparts were selected for a normal control group. Each subject was recorded videofluoroscopically while swallowing 5ml of a liquid of medium consistency. The occurrence of refusing to eat, mouth opening difficulty, incomplete oral closure, residue in the oral cavity, residue in the pharyngeal cavity, leakage and aspiration were observed. Each subject′s swallowing time and kinematic parameters were analyzed from the fluoroscopic videos. Results The incidence of refusing to eat (37.5%) and/or incomplete mouth closure (68.75%) were significantly higher in the observation group than in the other two groups. The incidence of difficulty in opening the mouth (37.5%), residue in the oral cavity (81.25%), residue in the pharyngeal cavity (56.25%), leakage (56.25%) and aspiration (50%) of the observation group were significantly higher in the observation group than among the normal controls, but were not significantly different from those incidences among the group without cognitive impairment. The average oral transit time and soft palate elevation time of the observation group were significantly longer than those of the other two groups. The observation group′s average hyoid movement time was significantly longer than that of the normal control group, but not significantly different from that of the group without cognitive impairment. There were no significant differences among the groups in average upper esophageal sphincter opening time, larynx closure time or the kinematic parameters. Conclusions Stroke survivors with dysphagia and cognitive impairment present dysphagia characteristic of oral phase swallowing difficulties. Key words: Stroke; Cognitive impairment; Dysphagia; Videofluoroscopy; Swallowing

Prevalence of sexual dysfunction in pregnancy.

This study aims to determine the prevalence of sexual dysfunction during pregnancy and to determine its associated factors. This 6-month cross-sectional study adopted convenience sampling; inclusion criteria were healthy pregnant women, sexually active and living together with their partner for 3months prior to recruitment into this study. Women who received advice to avoid sexual intercourse, with any medical illness and/or those conceived via assisted reproductive technology were excluded. Participants filled in a questionnaire consisting of demographic details and Malay Version Female Sexual Function Index Questionnaire. Data were analysed using SPSS 24.0; categorical data were analyzed by Chi-square and Fisher exact test. One hundred pregnant women with a mean age of 31 + 4.31years old participated. By using the cut-off FSFI score of 26.55, 81 (81%) participants were diagnosed to have sexual dysfunction. The mean FSFI score was 20.41 ± 8.45 (range 2.6-33.5; median 23.6). All the mean FSFI scores of first, second and third trimesters were low with 22.80 ± 10.67, 23.81 ± 7.18 and 18.74 ± 8.43, respectively. The mean score for desire, arousal, satisfaction and pain were significantly lower in the third trimester than earlier gestation. There was a significant difference in the incidence of difficulties in desire, arousal, lubrication, satisfaction and pain between first and second trimester combined, as compared to the third trimester of pregnancy. Trimester of pregnancy was found to have a significant association with the incidence of sexual dysfunction. Sexual dysfunction among pregnant women is a significant burden. Despite being a common health problem, it is often neglected.

Are French Fries a Vegetable? Lexical Typicality Judgement Differences in Deaf and Hearing Learners

Deaf and hard-of-hearing (DHH) learners are known to have vocabulary knowledge and language outcomes more heterogeneous than their hearing peers, with a greater incidence of difficulties presumably related (both as cause and effect) to documented challenges in academic domains. In particular, there is increasing evidence that differences may exist in the ways that semantic networks are structured and accessed in DHH and hearing learners. Individuals' judgments of word typicality offers a window into their semantic networks, revealing internal relationships in the mental lexicon. In the present study, 90 DHH and hearing college-aged learners provided typicality ratings at two points in time for 120 words common words considered to be central, borderline, or non-members of six categories. DHH and hearing participants differed in terms of their word knowledge, rating consistency, and rating magnitudes. Relative to hearing peers, DHH participants reported not knowing more of the words, but rated all words as being more typical than did hearing participants and rated the typicality of items more consistently over time. Implications of these findings for understanding mental lexicon structure for DHH and hearing learners, interpreting previous research, and constructing stimuli for future research are discussed.

Direct and indirect low skill fibre-optic intubation: A randomised crossover manikin study of six supraglottic airway devices.

Background and Aims:Fibre-optic intubation (FOI) through supraglottic airway devices (SADs) is useful in the management of the difficult airway. We compared two methods of FOI through seven SADs in a randomised crossover manikin study to assess each device's performance and discuss implications on SAD selection.Methods:Thirty anaesthetsiologists, 15 seniors and 15 juniors, each performed low skill FOI (LSFOI) with seven SADs using both 'direct' and 'indirect' methods. The order of method and device used were randomised. The primary end point was success rate of intubation; secondary end points were time taken for intubation, incidence of difficulties with direct and indirect LSFOI and operator device preference. Statistical analysis was with univariable analysis and comparison of proportions.Results:Data from six devices were analysed due to a protocol breach with one SAD. There was no difference in intubation success rate across all SADs and intubation methods. Intubation time was significantly shorter in AmbuAuragain than other SADs and shorter with the direct method of LSFOI than the indirect method (mean difference of 6.9 s, P = 0.027). Ambu Auragain had the least SAD and bronchoscope-related difficulties. Seniors had significantly shorter mean intubation times than juniors by 11.6 s (P = 0.0392). The most preferred SAD for both methods was AmbuAuragain.Conclusion:Low skill FOI consistently achieves a high intubation success rate regardless of experience, choice of method, or SAD used. SAD design features may significantly affect the performance of low skill FOI.

Effects of Pender health promotion mode on the compliance of the difficulty of mouth opening and mouth opening training in patients with nasopharyngeal carcinoma after radiotherapy

Objective To explore the effects of Pender health promotion mode on the compliance of mouth opening training, and reduce the of difficulty of mouth opening in patients with nasopharyngeal carcinoma after radiotherapy. Methods Totally 100 patients with nasopharyngeal carcinoma and treated with radiotherapy were randomly divided into the control group and the study group, with 50 cases in each group. Patients in the control group received routine opening training guidance, while patients in the study group received Pender health promotion model for nursing intervention based on the routine guidance. Results The compliance of patients in the study group was better than that in the control group six months after radiotherapy (U=236.3, P<0.01). The incidence of difficulty of mouth opening in the study group was lower than that in the control group six months and one year after radiotherapy (U=287.0, 334.5; P<0.01). Conclusions The Pender health promotion model comprehensively analyzes the influencing factors of patients with nasopharyngeal carcinoma. Nursing intervention measures for patients with nasopharyngeal carcinoma has important significance in promoting open mouth training compliance and reducing the incidence of difficulty in opening mouth after radiotherapy. Key words: Nasopharyngeal neoplasms; Pender health promotion mode; Difficulty of mouth opening; Functional training

Efficacy and Safety of Propiverine Hydrochloride for Overactive Bladder in Adult: a Systematic Review and Meta-analysis.

We carried out a systematic review and meta-analysis to assess the efficacy and safety of propiverine for treating overactive bladder (OAB) in adult. A literature review was performed to identify all published randomized placebo-controlled trials (RCT) of propiverine for the treatment of OAB. The search included the following databases: PUBMED and EMBASE. The reference lists of retrieved studies were also investigated. A systematic review and meta-analysis were conducted. Ten publications involving nine different RCTs were used in the analysis. We found that propiverine was effective in treating OAB in our meta-analysis. The decrease in number of micturitions/24h (P < 0.00001, the mean decrease was from 1.80 to 2.57) indicated that propiverine was more effective than the placebo. Propiverine also decrease the number of urgency, urgency incontinence, and nocturia and increase urine volume. However, the incidence of difficulty in voiding was higher with propiverine therapy compared with the placebo (P = 0.05, the mean percentage range from 0.34 to 4.93%). The decrease of total international prostate symptom score (IPSS) (P < 0.0001, the mean decrease was from 12.5 to 16.1) indicated that propiverine add a1-adrenoceptor antagonist was more effective in decreasing the lower urinary tract symptom (LUTS). The combination therapy also decreases the voiding symptom and storage symptom scores and increases maximum flow rate. This meta-analysis shows that propiverine is a safe and effective treatment for OAB. The major adverse event associated with propiverine treatment was difficulty in voiding. Propiverine add a1-adrenoceptor antagonist was more effective in terms of decreasing difficulty in voiding.

Anquiloglosia y amamantamiento: Revisión y reporte de caso

La anquiloglosia es una anormalidad congénita relativamente común del frenillo lingual que impide la protrusión y causa movimientos limitados de la lengua. Esta alteración en bebés es responsable del 25 a 60% de dificultades durante el amamantamiento. Presentamos una revisión enfocada en el diagnóstico, técnica quirúrgica y el reporte de caso clínico de un bebé.

Cognitive and Noncognitive Spectrum Mental Impairments in First-Degree Relatives of Patients with Alzheimer’s Disease

Cognitive and noncognitive spectrum impairments were studied in first-degree relatives of patients with Alzheimer’s disease (AD). A total of 134 relatives (mean age 47.6 years) were studied, of which 110 were children of probands and 24 were sisters or brothers. A high incidence of cognitive and noncognitive spectrum mental impairments was found in relatives of AD patients, and this was greater than the incidence in the control group (22 people who did not have relatives with AD). The relatives group showed twice the incidence of mild cognitive impairment (difficulty assimilating new information and impaired concentration of attention on tiring) than controls, with a 1.4-fold greater incidence of difficulty recalling distant events. Alzheimer’s phobia, and signs of irritable weakness were significantly more frequent. Signs of constitutional cognitive deficit were present in the history 2–4 times as commonly; signs of two or three different types of cognitive deficit were present 3–4 times more frequently. There was a 3.4-fold increase in combinations of signs of communicating hydrocephalus with MRI signs of cerebrovascular pathology. Information on these mental impairments of the cognitive and noncognitive spectra in first-degree relatives of AD patients may be of value as the basis of corrective and rehabilitative measures for the prophylaxis of progressive cognitive deficit.

A secure and rapid method for orotracheal intubation of laboratory rats utilising handy instruments

Tracheal intubation of anaesthetised rats for laboratory experiments remains an essential yet challenging procedure. We aimed to investigate whether tracheal intubation can be safely and securely accomplished in laboratory rats employing only handy instruments and with minimal experience. The feasibility and safety of a modified orotracheal intubation method was evaluated in rats undergoing open-chest surgery as part of another research protocol, and compared with an existing technique. The study was carried out in a tertiary medical centre-affiliated animal laboratory. Eighty-five rats weighing 250 to 350 g anaesthetised with intraperitoneal pentobarbital (60 mg kg(-1)). Orotracheal intubation was performed on 35 animals (group Jou) using a previously reported technique and then on another 50 rats (group New) using the modified method employing a 3-ml syringe-derived intubation wedge, a 0.025-inch guidewire and a 16-gauge 45-mm-long intravenous catheter. The time for completion, the number of attempts and the incidence of difficulties and complications were recorded. The intubated tracheas were subsequently examined macroscopically and microscopically to determine position of the intubation catheter and the integrity of epithelial lining. Compared with the previous technique, the new method was completed more rapidly (1 ± 0.2 vs. 5 ± 2.4 min; P < 0.001), more smoothly (difficulties encountered in 8 vs. 74%; P < 0.001), with greater overall success (100 vs. 86%; P=0.022) and with fewer attempts [1 (1 to 1) vs. 2 (2 to 4); P < 0.001) for the new and Jou techniques, respectively, and with a lower incidence of procedure-related complications. Postmortem analysis confirmed there was no microscopic injury to the tracheal epithelial lining with the new technique in contrast to 57% in those using the Jou technique (P < 0.001). Tracheal intubation for laboratory rats can be securely and safely completed with the modified method employing a short learning curve and easily available devices.

An examination of the validity of metaphor analysis studies

The last decade has seen a large number of studies employing metaphor elicitation techniques, especially using ‘X is (like) Y’ format to investigate language teachers’ and learners’ understandings of teaching and/or learning. Although a few recent studies have reported the proportion of unsuccessful answers to this type of task, and identified a number of issues connected with task difficulty, there appears to be little published work that has seriously addressed the validity of the method used. The aims of this paper are therefore to explore the discourse and contexts where failure/difficulty with the metaphor elicitation task occurs, to try and understand what causes the problems and to suggest approaches to resolving them. In so doing, this paper reports on two small-scale metaphor analysis studies that were primarily designed to reduce the incidence of difficulty with ‘X is (like) Y’ metaphor prompts, presenting the perceived reasons for the difficulties and discussing possible solutions by introducing training in the form of four ready-made metaphor related teaching sessions. Essentially, I argue that training both about metaphor and in using it are important, and that thought needs to be given to both the nature and the length of training. The hope is that the present paper can be a first step and will serve to shed light on the ways that can be employed by metaphor researchers to identify and then resolve their methodological problems.

Usefulness of Pre-Procedure Cavotricuspid Isthmus Imaging by Modified Transthoracic Echocardiography for Predicting Outcome of Isthmus-Dependent Atrial Flutter Ablation

Anatomic characteristics of the cavotricuspid isthmus (CTI) have been reported to be related to the outcome of atrial flutter ablation therapy. However, preprocedural evaluation of CTI anatomy using modified transthoracic echocardiography to guide atrial flutter ablation has not been well described. Transthoracic echocardiography was prospectively performed before atrial flutter ablation in 42 patients with typical CTI-dependent atrial flutter. A modified apical long-axis view was designed to visualize and evaluate anatomic characteristics of the CTI and Eustachian ridge (ER). A prominent ER, extending from the inferior vena cava to the interatrial septum, is defined as an extensive ER. Twenty-eight patients had straightforward ablation procedures, and 14 patients had difficult ablation procedures. Two patients with difficult procedures had unsuccessful ablation. Multivariate analysis (using CTI length, the presence of a pouch or recess, ER morphology, and significant tricuspid regurgitation as variables) showed that the presence of extensive ER was the only independent predictor of a difficult ablation procedure. The ablation time in patients with extensive ER (n= 13) was significantly longer than in those patients with nonextensive ER (n= 29) (1,638.4 ± 1,548.3 vs 413.8 ± 195.5 sec, P= .015). The incidence of difficulty in achieving bidirectional isthmus block was also higher in patients with extensive ER (10 of 13 vs four of 29, P < .001). Preprocedural transthoracic echocardiography using a modified apical long-axis view is useful to characterize the morphology of the CTI and the ER. An extensive ER is a strong predictor for difficult ablation of CTI-dependent atrial flutter.

A comparison of the upper lip bite test with hyomental/thyrosternal distances and mandible length in predicting difficulty in intubation: A prospective study

The incidence of difficulty in tracheal intubation has been reported to range from 0.5 to 18% in patients undergoing surgery. We aimed to elucidate the role of upper lip bite test (ULBT) with other prevailing tests, hyomental/thyrosternal distances (HMD/TSD), and the mandible length (ML) and their possible correlation in predicting difficulty in intubation. After institutional approval and informed consent were obtained, 300 consecutive patients aged 20–60 years of ASA physical status I and II, scheduled for elective surgical procedures requiring tracheal intubation and meeting the inclusion criteria, were enrolled in this study. Each patient was evaluated regarding ULBT, HMD, TSD and ML. Laryngoscopy was assessed by an attending anaesthesiologist blinded to the measurements. The laryngoscopic result was graded according to Cormack and Lehane’s Grading system. The negative predictive value (NPV) and positive predictive value (PPV) of ULBT were found to be 94 and 100%, respectively. These corresponding figures for TSD were 88.5 and 0%, respectively. Specificities for ULBT, HMD, ML and TSD were 100, 98.9, 98.9 and 98.1%, respectively. ULBT class and laryngoscopic grading showed the greatest agreement (kappa = 0.61, P < 0.001). An agreement between laryngoscopic grading and HMD and ML also existed (0.003 and <0.001, respectively), but was comparatively weaker. The high specificity, NPV, PPV and accuracy of ULBT as revealed in this study could be a good rationale for its application in the prediction of difficulty or easiness in intubation. ML > 9 cm and HMD > 3.5 cm were good predictors of negative difficult intubation.

Improving access to HCV treatment: External jugular venepuncture can overcome problems with difficult venous access

Many patients requiring antiviral treatment of chronic hepatitis C (HCV) have a background of significant injection drug use (IDU). In a proportion of patients, IDU results in difficulty with blood collection from conventional sites. We audited patients from the Liver Clinics and Drug Health Pharmacotherapy Service of The Royal Prince Alfred Hospital (RPAH) to determine the incidence of difficulty with blood collection. This survey identified the need for an innovative venous access strategy to better manage this group of patients. An external jugular venepuncture (EJV) protocol and education package was developed in collaboration with the Department of Anaesthetics, Gastroenterology and Liver Centre and HCV clinical nurse consultants (CNC). RPAH policy and procedure committee approved the protocol and patient information sheet. Patients with a history of difficulty with blood collection were eligible for the protocol. Patient satisfaction surveys were conducted. The initial survey of patients from the liver clinics and pharmacotherapy service identified that 48 percent had difficulty with blood collection from conventional sites. In the period October 2002 to July 2006, 29 patients (89 percent with history of IDU) were referred for EJV assessment. Major indications for EJV were for blood testing for initiation and monitoring of antiviral therapy and ongoing assessment of HCV infected patients. No adverse events resulted from the procedure. All patients surveyed report high levels of satisfaction with the technique compared to previous venous access attempts. EJV improves access to antiviral therapy and is a safe and effective technique for patients with difficult venous access (DVA). In addition, we have utilised EJV for post-transplant care of patients and used external jugular vein cannulation as vascular access for contrast imaging in hepatocellular carcinoma (HCC) assessment.

Airway Management in Patients With Pituitary Disease

Difficulties in airway management are observed among patients with pituitary disease. The purpose of this study was to better characterize the relationship between disease factors such as tumor characteristics on difficult endotracheal intubation. The perioperative records of 746 patients that underwent transsphenoidal microsurgery at the University of Virginia between January 1995 and June 2001 were reviewed. Among the 746 patients studied, difficulty with endotracheal intubation was encountered in 28 patients (3.8%). Patient gender and tumor size were not associated with a difference in the incidence of unanticipated airway management difficulty. Unanticipated difficulty with airway management was more than three times more common in acromegalic patients (n = 121) than in patients with nonfunctioning pituitary tumors (9.1% [5.8-14%] vs 2.6% [1.5-4.5%], P = 0.007). Patients with Cushing disease (n = 182) and patients with a prolactinoma (n = 87) were no more difficult to intubate than patients with nonfunctioning tumors. Among patients with acromegaly, neither tumor size nor patient gender has any impact on the incidence of intubation difficulty. Among all patients, when difficulty was encountered, intubation assisted by the gum elastic bougie was successful 100% of the time. The incidence of difficulty in intubation is not higher among patients with pituitary disease than in the general surgical population; however, patients with acromegaly have difficult intubations three times more often.

Tracheal intubation in obstetrics: incidence of difficulty among various grades of anaesthetists

Tracheal intubation in obstetrics: incidence of difficulty among various grades of anaesthetists

Problems, obstacles and complications with transpalatal distraction in non-congenital deformities

Introduction: The transpalatal distractor is a bone-borne device that eliminates negative orthodontic effects during and after maxillary expansion. It produces virtually parallel expansion in the coronal plane. Orthodontic appliances can be installed at an earlier date than when tooth-borne expanders are used. Our aim was to improve the technique by reviewing the difficulties encountered during applications in the past. Patients and Methods: The files of 57 patients were analyzed for problems (difficulties requiring surgical intervention), obstacles (difficulties requiring surgical intervention but not interfering with the result), and complications (difficulties not resolved at the end of the treatment). Results: Twenty-nine difficulties occurred. In 25 cases they were considered to be a ‘problem’. Nine problems were surgery related and 16 problems were related to the distraction device itself (14 episodes of loosening of the module, two instances of loss of one osteosynthesis screw). ‘Obstacles’ occurred in three cases, i.e. loosening of an abutment plate. There was only one ‘complication’: unilateral infraorbital hyposensibility in a case of a high level corticotomy. Conclusion: The expansion goal was achieved in all patients. Loosening of the module proved to be the major cause of discomfort. The incidence of difficulties has lead to a change in the design of the hardware and in the surgical protocol. Copyright 2002 European Association for Cranio-Maxillofacial Surgery. Published by Elsevier Science Ltd. All rights reserved.

The Effect of Goiter on Endotracheal Intubation

The incidence of difficulty in tracheal intubation in the presence of goiter was investigated.Data were collected in a series of 4742 consecutive adult patients undergoing general anesthesia. The prevalence of goiter was 6.8%. Fifteen anesthesiologists performed the preoperative airway assessment using standardized guidelines. Seven individual risk factors were correlated with the potential for difficult tracheal intubation. Whenever evidence of goiter or airway pathology was observed, the evaluation was completed by indirect laryngoscopy and radiologic examination to establish the presence of any anatomical deviation. Difficult intubation was defined as inadequate exposure of the glottis by direct laryngoscopy. There was no difference in probability of difficulty in tracheal intubation between patients who presented for thyroidectomy and patients with goiter estimated as a random finding. Statistical analysis revealed an increased risk of difficult intubation amongst goiter patients compared with patients with no evidence of any risk factor (6.8% vs 0.9%, P < 10-8, relative risk = 7.4). We conclude that goiter, when accompanied by airway deformity, constitutes an aggravating factor for difficult intubation. (Anesth Analg 1997;84:611-2)

The effect of goiter on endotracheal intubation.

The incidence of difficulty in tracheal intubation in the presence of goiter was investigated. Data were collected in a series of 4742 consecutive adult patients undergoing general anesthesia. The prevalence of goiter was 6.8%. Fifteen anesthesiologists performed the preoperative airway assessment using standardized guidelines. Seven individual risk factors were correlated with the potential for difficult tracheal intubation. Whenever evidence of goiter or airway pathology was observed, the evaluation was completed by indirect laryngoscopy and radiologic examination to establish the presence of any anatomical deviation. Difficult intubation was defined as inadequate exposure of the glottis by direct laryngoscopy. There was no difference in probability of difficulty in tracheal intubation between patients who presented for thyroidectomy and patients with goiter estimated as a random finding. Statistical analysis revealed an increased risk of difficult intubation amongst goiter patients compared with patients with no evidence of any risk factor (6.8% vs 0.9%, P < 10(-8), relative risk = 7.4). We conclude that goiter, when accompanied by airway deformity, constitutes an aggravating factor for difficult intubation.