Thyromental Distance Research Articles

Ultrasound-Measured Skin-to-Epiglottis Distance as a Predictor of Difficult Intubation in Obese Patients: A Prospective Observational Study

Background/Objectives: Difficult intubation is a significant clinical issue in emergency medicine as well as anesthesia practice, occurring more frequently in obese patients. Traditional assessment methods may not be sufficient to predict difficult intubation. This study aims to evaluate the ability of ultrasound-measured skin-to-epiglottis distance (SED) to predict difficult laryngoscopy in obese patients and investigate its applicability in clinical practice. Methods: This prospective observational study was conducted between February 2024 and January 2025 at Gaziantep City Hospital on obese patients undergoing bariatric surgery. Patients aged 18 years and older with an American Society of Anesthesiologists (ASA) classification of I-II-III were included in the study. Demographic data, standard airway assessment parameters (neck circumference, thyromental distance, sternomental distance, etc.), and ultrasound-measured skin-to-epiglottis distance were recorded. All intubation procedures were performed by a single experienced anesthesiologist following standard protocols, and laryngoscope view was assessed according to the Cormack–Lehane classification. Results: Among the 61 patients included in the study, 16.4% were classified as having a difficult airway, and 13.1% experienced difficult intubation. No significant correlation was found between standard airway assessment parameters and difficult intubation. However, ultrasound-measured skin-to-epiglottis distance (SED) was significantly higher in patients with difficult intubation (p = 0.004), making it a strong predictor. Additionally, modified Mallampati (p < 0.001), modified Cormack–Lehane (p = 0.003), and Wilson scores (p = 0.001) were significant in predicting difficult airway, although Wilson score was not significant for difficult intubation (p = 0.099). Conclusions: Our study suggests that ultrasound-measured skin-to-epiglottis distance may be a valuable predictor of difficult intubation in obese patients. Given the limitations of preoperative assessment methods, incorporating ultrasound into airway evaluation as a complementary tool provides significant benefits. Larger-scale studies in the future are necessary to further assess the clinical efficacy of this method.

Investigating the Airway Assessment of COPD Patients Based on the SARI Protocol: A Descriptive Cross-Sectional Study

Introduction: Airway management is crucial in patients with chronic obstructive pulmonary disease (COPD) undergoing surgery due to their heightened risk of respiratory complications. COPD is a chronic inflammatory condition that results in airway narrowing, rendering patients more susceptible to stressful situations such as surgery. Therefore, it is essential to conduct thorough preoperative airway assessments to prevent complications and enhance patient outcomes. Methods: This cross-sectional descriptive study was conducted in Hamedan hospitals and included 400 randomly selected COPD patients undergoing surgery. The Simple Airway Risk Index (SARI) was utilized to assess intubation difficulty, taking into account parameters such as mouth opening, thyromental distance, and Mallampati score. The collected data was analyzed using SPSS software, and relationships between variables were examined using ANOVA and t-tests. Results: The study revealed a significant association between SARI score and factors such as gender, age, BMI, and certain medical conditions. For instance, male patients and those over 30 years of age exhibited higher SARI scores, signifying an elevated risk of difficult intubation. Moreover, conditions like hypertension and diabetes demonstrated a correlation with higher SARI scores. Conclusion: The SARI score proves to be a valuable tool for predicting airway management challenges in COPD patients. This study underscores the significance of comprehensive preoperative airway assessments employing the SARI score to anticipate and mitigate potential complications, thereby enhancing the quality of surgical care for COPD patients.

Comparison of direct and indirect images and hemodynamic response of two different video laryngoscopes to tracheal intubation

AimsThe aim of this study was to compare the effects of two different videolaryngoscopes (VLs) on direct (through the mouth) and indirect (screen images) laryngoscopy and to evaluate their effects on hemodynamic response.Settings and designA total of 70 patients between the ages of 18 and 65 years with ASA I-III physical status, planned for general anesthesia, with an expected difficult airway, were included in the study. Patients were enrolled in the study between 02/ 2022 and 06/ 2022. Patients were randomly divided into two groups. McGrath video laryngoscope was used in Group MC and Hugemed video laryngoscope was used in Group H. Modified Cormack Lehane and POGO scores (Percentage of glottic opening) of all patients on direct and indirect laryngoscopy were evaluated and recorded and then orotracheal intubation was performed. Demographic data, ASA status, Mallampati classification, thyromental distances and mouth opening were recorded. Standard monitoring was applied to all patients. During intubation, endotracheal intubation time, number of attempts, intubation-related complications and sore throat were recorded. Hemodynamic parameters (mean arterial pressure, peripheral oxygen saturation values) were recorded before, after induction and after intubation.ResultsThere was no difference between the groups in terms of descriptive characteristics (p > 0.05). When direct and indirect POGO scores were compared in group MC, no difference was found between the patients (p > 0.05). When direct and indirect POGO scores were compared, no difference was found between patients in Group H (p > 0.05). The mean POGO VL indirect score of Group H patients was found to be significantly higher than that of Group MC (p < 0.035) Both VLs showed similar results in terms of intubation time, number of attempts and hemodynamic findings.ConclusionsMcGrath and Hugemed videolaryngoscopes provide a good laryngeal view with similar Cormack Lehane scores during non-difficult endotracheal intubation and facilitate successful intubation by maintaining hemodynamic stability. It was observed that the Hugemed VL had a better indirect POGO score, but the images provided by the blades of both VLs on direct laryngoscopy allowed intubation.Clinical Trials Registration NumberNCT06649526. Clinical trials registration date 17/10/2024 ‘’retrospectively registered’”.

Comparison of Neck Circumference at the Hyoid and Thyroid Levels, Neck Circumference to Thyromental Distance Ratio, and Hyomental Distance Ratio in Predicting Difficult Laryngeal Visualization in Obese and Non-Obese Populations.

Several preoperative predictive factors for difficult visualization of the larynx (DVL) have been identified, and these factors have significant predictive value in the obese population. This prospective observational study was conducted to compare the predictive abilities of different airway predictors between obese and non-obese populations. Our study included a total of 90 patients, divided into two groups based on body mass index (BMI): group O (obese) with BMI >30 kg/m² and group NO (non-obese) with BMI <30 kg/m². The patients were evaluated using the modified Mallampati grade (MMG), neck circumference at the level of the hyoid (NCh) and thyroid (NCt), thyromental distance (TMD), and hyomental distance (HMD) in both neutral and extended head positions in both groups. The modified Cormack and Lehane(MCL) grading for visualization of the larynx was observed during direct laryngoscopy prior to intubation. MCL grades 2b, 3, and 4 were considered indicative of DVL in this study. DVL was observed in 41.1% of the population, 46.7% of the obese (O) group, and 35.6% of the non-obese (NO) group. MMG was statistically significant only in the O group for predicting the DVL with a specificity of 85.1%. In the NO group, MMG ≥3 was not significant statistically and showed a specificity of 70.8%. NCh and NCt had no statistically significant difference in differentiating the DVL between obese and non-obese groups. NCt/TMD in the O group with a cut-off value of 5.135 had a sensitivity of 61.9% and a specificity of 58.3% and predicted DVL only in the obese group. Hyomental distance ratio (HMDR) was a statistically significant index in both groups and has a good predictive utility for the DVL. An HMDR ≤1.23 had a sensitivity of 68.8% and a specificity of 72.4% in the non-obese population. An HMDR ≤1.20 in the obese group had a sensitivity of 85.7% and a specificity of 91.7%. The higher incidence of DVL (MCL grades 2b, 3, and 4) in the obesepopulation when compared to the non-obese population was not statistically significant. NCt and NCh had minimal value as predictors of DVL. This study concludes that HMDR was a reliable airway assessment tool irrespective of BMI, while MMG and NCt/TMD were reliable difficult airway predictorsbut only in the obese population.

Difficult Laryngoscopy Experienced by In-training Anesthesiologists in Apparently Normal Indian Surgical Population. How Much Does Optimal External Laryngeal Manipulation Help?

Abstract Background: The incidence of difficult laryngoscopy among in-training anesthesiologists remains unclear. In addition, the effectiveness of optimal external laryngeal manipulation (OELM) in enhancing the laryngoscopic view during elective intubations by these trainees has not been assessed. Aim: This study aimed to determine the incidence of difficult laryngoscopy, defined by the Cormack–Lehane grading system, and to evaluate the impact of OELM on the laryngoscopic view. Furthermore, the diagnostic accuracy of five difficult airway predictors (upper lip bite test, Mallampati classification, atlanto-occipital extension, thyromental distance, and interincisor gap) was examined. Methodology: This prospective observational study was conducted at a 1000-bed tertiary care hospital. Patients undergoing general anesthesia were included, except those requiring nasal intubation, laryngeal mask airways, ASA grades III–IV, faciomaxillary trauma, airway tumors, or emergency intubation. Operators were anesthesiologists with at least six months of training and 100 intubations. Preoperative airway assessments included the upper lip bite test (ULBT), Mallampati score, atlanto-occipital extension, thyromental distance, and interincisor gap. Laryngoscopy was performed after induction with thiopentone and vecuronium, with ventilation confirmed. The laryngeal view was graded per Cormack–Lehane criteria. Optimal external laryngeal manipulation (OELM) was applied if needed. A senior anesthesiologist supervised all procedures. With an estimated difficult laryngoscopy prevalence of 18%, the required sample was 1750; 1914 patients were included. Ethics approval was obtained, and the study was registered (CTRI/2016/01/006510). Statistical analysis was conducted using SPSS v17 and WINPEPI v11. Results: Of 1914 laryngoscopic attempts, 18.7% were difficult (grades 3 and 4). OELM significantly reduced the incidence of difficult views to 4.44% (P &lt; 0.001), with no failed intubations. The study concluded that in-training anesthesiologists encounter difficult laryngoscopic views in about one in five cases. However, the five airway predictors studied showed limited effectiveness as screening tools for difficult laryngoscopy, while OELM proved to be a valuable technique for improving laryngoscopic views during elective intubations. Conclusions: Almost one in five laryngoscopic views encountered by in-training anesthesiologists is difficult (Cormack–Lehane grade 3 or 4). The five different airway predictors studied found that these tests were poor for screening predicting difficult laryngoscopy. OELM is a “handy” technique to improve difficult laryngoscopic view during elective intubations.

Prediction of Postoperative Sore Throat in Patients After Day-case Surgery With General Anesthesia: A Retrospective Study

Prediction of Postoperative Sore Throat in Patients After Day-case Surgery With General Anesthesia: A Retrospective Study

Comparison of Inter-Incisor Distance as a Predictor of Difficult Intubation in Men and Women-A Prospective Observational Study.

Most of the studies on difficult intubation and laryngoscopy focused on American and European populations. However, Indians have distinct anthropometric characteristics compared to these populations. This study aims to determine the gender difference in inter-incisor distance (IID) cut-off marks to assess the ease of intubation in the Indian population. A prospective observational study was conducted on 516 patients scheduled for elective surgery under general anesthesia with endotracheal intubation. Preoperative assessments included IID, thyromental distance, neck circumference, sternomental distance (SMD), thyrohyoid distance, mentohyoid distance, and modified mallampatti grading. Intubation difficulty scores (IDSs) were assessed during intubation. The optimal cut-off values of inter incisor gap and difficult intubation were analyzed by receiver operating characteristic curve analysis. The total cohort was grouped into males (Group 1 [n = 258]) and females (Group 2 [n = 258]). Males had a significantly higher mean age (P = 0.04) and weight (P = 0.00) than females. Difficult intubation incidence was 16.3% of males and 6.2% of females. Increased IID (P = 0.039), decreased SMD (P = 0.046), and males (P = 0.002) are identified as predictors of difficult intubation.IID and IDS showed greater specificity than sensitivity, with significant cut-off values of 4.25 and 1.50, respectively. The cut-off value of IID did not show a significant difference in gender variation. Despite the low IID in females, intubation difficulties were not observed compared to males.

Height to thyromental distance ratio and height to sternomental distance ratio comparison as difficult airway predictors: A cross-sectional study

: Difficult airway management is a critical concern in anesthesiology, contributing significantly to perioperative morbidity and mortality. Preoperative evaluation using predictive parameters like the Height-to-Thyromental Distance (RHTMD) ratio and the Height-to-Sternomental Distance (RHSMD) ratio aids in identifying patients at risk of difficult intubation. This study aimed to compare RHTMD and RHSMD as predictors of difficult airways in patients undergoing elective surgeries under general anesthesia.: A cross-sectional study was conducted involving 150 patients undergoing elective surgeries under general anesthesia. Airway assessments included measurements of Thyromental Distance (TMD), Sternomental Distance (SMD), RHTMD, RHSMD, weight, and height. Direct laryngoscopy was performed using a Macintosh blade by an anesthetist with over three years of experience, and the Cormack-Lehane grade was recorded. Institutional anesthesia protocols were uniformly applied. Using the Cormack-Lehane grade as the reference standard, RHTMD demonstrated a sensitivity of 88.9%, specificity of 97.7%, and accuracy of 96.67%. RHSMD showed a sensitivity of 83.3%, specificity of 95.5%, and accuracy of 94%.: The Height-to-Thyromental Distance ratio was found to be a more sensitive, specific, and accurate predictor of difficult airways compared to the Height-to-Sternomental Distance ratio. Combining both parameters further improved the predictive reliability, emphasizing the need for an integrated assessment approach in airway evaluation.

The Evaluation and Modification of Standard Airway Assessment Tests for Virtual Anaesthetic Assessments: A Pilot Study.

Background/Objectives: Virtual preoperative anaesthetic assessments can significantly reduce healthcare costs and improve patient convenience. The challenge with virtual consults is often the airway assessments, which screen for potentially difficult airways (PDAs). The objective of this pilot study was to determine the reliability of standard airway screening tests for detecting PDAs when conducted virtually. Methods: An observational longitudinal study was conducted between July 2021 and April 2022 at a tertiary hospital in Singapore. We compared the Mallampati score (MS), upper lip bite test (ULBT), thyromental distance, mouth opening test, and neck movements in 94 patients, first during virtual assessments before surgery and subsequently at face-to-face preoperative assessments (gold standard) on the day of surgery by the same team of anaesthesiology trainees. Goodman and Kruskal's gamma coefficient measured concordance between virtual and face-to-face assessment results. Logistic regression (LR) identified virtual predictors of PDAs in clinical practice. AUROC values informed tool performance. Results: LR showed that elevated virtual MS, virtual ULBT, and body mass index (BMI) were potential predictors of clinical PDAs. Termed the "MBBS", this collective score showed good performance with a sensitivity of 95% and an AUROC of 0.79. Importantly, all screening tests performed poorly in virtual assessments when applied individually (sensitivity < 50%). Conclusions: In this pilot study, BMI combined with MS and ULBT could reliably detect PDAs during virtual airway assessments. The data herein support further large multi-centre studies to validate the MBBS for clinical use.

Evaluation of ultrasound measured tongue thickness, tongue thickness-thyromental distance ratio, and skin-to-epiglottis distance in predicting unanticipated difficult laryngoscopy.

The contemporary literature review suggests upper airway ultrasound can help us to diagnose an unanticipated difficult airway before laryngoscopy. The primary objective of this study was to compare ultrasonography (USG) and clinical airway indices across easy and difficult laryngoscopy groups. This prospective observational study included 258 patients scheduled to undergo surgery under general anesthesia with endotracheal intubation. Ultrasonographic upper airway parameters, viz., tongue thickness (TT), skin-to-epiglottis distance (DSE), and tongue thickness to thyromental distance ratio (TT/TMD) were measured. Patients were identified as easy or difficult laryngoscopy groups based on their Cormack Lehane (CL) grading. Out of 258 patients, 20 (7.75%) had difficult laryngoscopy, and 238 (92%) had easy laryngoscopy. The USG measured TT mean, and median values were 6.16 ± 0.39 [6.10] cm in difficult and 5.41 ± 0.36 [5.40] cm in easy laryngoscopy groups. The USG measured mean and median value of DSE were 2.75 ± 0.09 [2.74] in difficult and 2.27 ± 0.23 [2.27] in easy laryngoscopy groups. The ratio of TT/TMD with mean and median values of 0.98 ± 0.07 [0.99] in difficult and 0.84 ± 0.13 [0.82] in easy laryngoscopy. Using the inputs, the diagnostic accuracy of the ultrasound-measured significant variables was calculated in terms of their area under the curve using the receiver operating characteristic curve. This study revealed a relationship between sonographic measurements like TT, DSE, and TT/TMD ratio for easy and difficult laryngoscopy identification. Including these sonographic parameters and their cut-off values may enhance our ability to predict an unanticipated difficult laryngoscopy.

A comparative study between tongue thickness measured by ultrasonography and thyromental distance in anticipation of difficult intubation

A comparative study between tongue thickness measured by ultrasonography and thyromental distance in anticipation of difficult intubation

Comparative evaluation of first-attempt intubation success rate using direct laryngoscope with Macintosh blade and video laryngoscope during rapid sequence induction in patients undergoing emergency surgery: A prospective randomised controlled trial.

Airway management skills form the cornerstone of routine anaesthesia practice. Its role becomes more significant in emergency areas where time is of the essence. Patients presenting for emergency surgery require definitive airway management with endotracheal intubation. Rapid sequence induction with direct laryngoscopy using a Macintosh blade has been used consistently with varying success. With the advent of video laryngoscopes, their utility is being explored in emergency areas. We aimed to assess the role of a video laryngoscope (Medizintechnik, Sulz, Germany) in rapid sequence induction and intubation during emergency surgeries. We hypothesised that video laryngoscope would improve the first-attempt intubation success rate in patients undergoing emergency surgery. In total, 76 patients presenting for emergency surgery were enrolled and randomly assigned into two groups (38 each), who were intubated with either a video laryngoscope or Macintosh blade during rapid sequence induction. This study aimed to compare and evaluate direct laryngoscopy using a Macintosh blade and a video laryngoscope during rapid sequence induction. The two groups were similar in the type and indication for surgery. Airway characteristics were also compared, and there were no significant differences in all airway parameters, including mouth opening, thyromental distance, Mallampati grading and neck circumference. The first-attempt intubation success rate was significantly higher in the video laryngoscope group (p = 0.017, χ2 = 5.684). The Cormack-Lehane grade distribution was compared in both groups, with better glottis visualisation in group video laryngoscope (p = 0.028, χ2 = 9.123). This prospective, randomised, controlled study aimed to compare the first-attempt intubation success rate using direct laryngoscopy with a Macintosh blade and a video laryngoscope during rapid sequence induction in patients undergoing emergency surgeries and observed that first-attempt intubation success rate was significantly higher in group video laryngoscope (86.8%) than in group direct laryngoscopy (63.2%). Therefore, video laryngoscopy offers an attractive alternative to conventional laryngoscopy while securing the airway in patients presenting for emergency surgery.

Comparison of Routine Preoperative Ultrasound-Guided Airway Examination Versus Clinical Airway Examination in Predicting Difficult Laryngoscopy in Patients Coming for Elective Surgery: An Observational Study.

Background As part of preoperative patient evaluations, it is customary to estimate the likelihood of difficulties during laryngoscopy and intubation. A diverse array of predictors is frequently employed by anesthesiologists to anticipate difficult laryngoscopy (DL); however, no single predictor has been established as the gold standard. In the present study, we compared routine preoperative ultrasound-guided airway examination and clinical airway examination in predicting DL in patients coming for elective surgery. Methodology The present study is a single-blinded observational study that spanned 12 months, beginning in March 2018 and concluding in February 2019. The study took place at Kovai Medical Center and Hospital (KMCH), which is a tertiary-care facility in Coimbatore, India. The data were obtained through face-to-face interviews, with a sample size of 135 research participants. The questionnaire contained comprehensive data regarding the patient's age, weight, gender, comorbidities, planned surgery, and preoperative assessment, which encompassed a detailed examination of the airway. The clinical airway examination comprised assessing mouth opening, performing the modified Mallampati test, measuring thyromental height (TMH) and thyromental distance (TMD), evaluating neck circumference, and observing neck extension. Ultrasound-guided airway examination was performed during the immediate pre-operative period, focusing on specific parameters such as the pre-epiglottic space, anterior neck soft tissue at the level of vocal cords, thyrohyoid membrane, suprasternal notch, hyoid bone (single parameter measured at different levels), hyo-mental ratio, and tongue volume (TV). Results Among the ultrasound parameters, TV (72.15 cm3) is the best ultrasound parameter to predict DL (95%CI: 0.65 to 0.82), with a high sensitivity of 82% and specificity of 45.88%. Other parameters that are useful are anterior neck soft tissue at the level of the thyrohyoid membrane (0.67 cm), suprasternal notch (1.01 cm), and, lastly, pre-epiglottic space (0.57 cm). Among clinical parameters, modified Mallampati grade (grade 3 or more) is the best parameter to assess the airway clinically and predict DL, followed by neck circumference (>42 cm) and TMH (>5 cm). Based on the findings, we observed that both clinical and ultrasound parameters are comparable to predict DL. Conclusion We observed that routine clinical airway examination and ultrasound examination yielded comparable results in predicting DL. Therefore, the routine use of clinical airway examination still holds good in predicting DL.

Comparison of Upper Lip Bite Test and Thyromental Distance with Other Airway (Malampatti and Inter Incisor Distance) Assessment Tests for Predicting Difficult Endotracheal Intubation

Objective: To study the ability of upper lip bite test and thyromental distance to predict difficult endotracheal intubation when compared to standard assessment tests such as Mallampati and inter incisor distance. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Anesthesiology, Pak-Emirates Military Hospital, Rawalpindi, Pakistan, Sep 2020 to Mar 2021. Methodology: We studied a total of 50 patients who reported for the administration of general anesthesia. All patients underwent evaluation with modified Mallampati test, upper lip bite test and thyromental distance test. All participants underwent subsequent intubation according to a standard protocol. The researcher documented difficult intubations. Results: We found the upper lip bite test to have a sensitivity of 75.7%, a specificity of 84.2%, and a diagnostic accuracy of 78.6%. Thyromental distance had a sensitivity, specificity, and diagnostic accuracy of 51.4%, 78.9% and 60.7%, respectively while the modified Mallampati had a sensitivity of 64.9%, 89.5%, specificity and a diagnostic accuracy of 73.2%. Conclusion: Upper lip bite test is a useful bedside assessment tool with which to predict the probability of a difficult endotracheal intubation. Height to thyromental distance ratio test is also acceptable for rapid assessment.

Acromio-Axillo-Suprasternal Notch Index Performance in Predicting Difficult Visualization of the Larynx: An Observational Prospective Study.

Bedside screening tests for predicting difficult intubation play a crucial role in clinical practice, although their utility remains limited. This prospective observational study aimed to assess the predictive value of the Acromio-Axillo-Suprasternal Notch Index (AASI) for difficult visualization of the larynx (DVL). Following approval from the Institutional Ethics Sub-Committee (Research Protocol No.: IESC/FP/68/2023), this prospective, observational, single-center study involved a sample size of 100 consecutive adult patients, both male and female, aged 20 to 65 years. The participants were classified as American Society of Anesthesiologists (ASA) grade I or II and were scheduled for elective surgeries necessitating endotracheal intubation.Before the operation, the following factors were assessed: AASI, modified Mallampati test (MMT), sternomental distance (SMD), thyromental distance (TMD), and inter-incisor distance (IID). Larynx visualization was evaluated using the Cormack-Lehane (CL) grading system, where grades III and IV indicate difficult laryngeal visualization. Qualified anesthesiologists performed direct laryngoscopy while remaining unaware of the outcomes of the airway predictors being assessed. The main aim of the investigation was to assess the efficacy of the AASI as a means of predicting DVL. The research study's secondary goals involved evaluating the accuracy of AASI in predicting challenging airways compared to other predictors such as MMT, SMD, TMD, and IID. DVL was observed in 21% of patients, out of which 10 and 11 were males and females, respectively. The sensitivity, specificity, and area under the curve (AUC) of the AASI were observed and reported with a 95% confidence interval (CI), being 98.73% (93.2-99.9%), 71.43% (47.8-88.7%), and 0.851 (0.732-0.970), respectively. AUC analysis revealed that AASI outperformed MMT, SMD, TMD, and IID as a predictor of DVL. AASI (≥0.5) serves as an excellent predictor for DVL during direct laryngoscopy. This finding suggests the clinical utility of AASI in identifying patients who may require special consideration during intubation procedures.

Assessment of predictive value of thyromental height in predicting difficult laryngoscopy compared with Mallampati, and thyromental distance among surgical patient who will take general anesthesia at selected governmental hospital cross-sectional study: Ethiopia, 2022.

Assessment of predictive value of thyromental height in predicting difficult laryngoscopy compared with Mallampati, and thyromental distance among surgical patient who will take general anesthesia at selected governmental hospital cross-sectional study: Ethiopia, 2022.

Comparison of two different positions of an anaesthesiologist for ease of endotracheal intubation in adult patients: A randomised control trial

Comparison of two different positions of an anaesthesiologist for ease of endotracheal intubation in adult patients: A randomised control trial

Effects of head and neck radiotherapy on airway management outcomes

Effects of head and neck radiotherapy on airway management outcomes

Difficult Airway Prediction in Infants with Apparently Normal Face and Neck Features.

Background/Objectives: Prediction of a difficult airway during pre-anesthetic evaluation is of great importance because it enables an adequate anesthetic approach and airway management. As there is a scarcity of prospective studies evaluating the role of anthropometric measures of the face and neck in predicting difficult airways in infants with an apparently normal airway, we aimed to identify the aforementioned predictors of difficult facemask ventilation and intubation in infants. Methods: A prospective, observational study that included 97 infants requiring general endotracheal anesthesia was conducted. Anthropometric and specific facial measurements were obtained before ventilation and intubation. Results: The incidence of difficult facemask ventilation was 15.5% and 38.1% for difficult intubation. SMD (sternomental distance), TMA (tragus-to-mouth angle distance), NL (neck length) and mouth opening were significantly lower in the difficult facemask ventilation group. HMDn (hyomental distance in neutral head position), HMDe (hyomental distance in neck extension), TMD (thyromental distance), SMD, mandibular development and mouth opening were significantly different in the intubation difficulty group compared to the non-difficult group. HMDn and HMDe showed significantly greater specificities for difficult intubation (83.8% and 76.7%, respectively), while higher sensitivities were observed in TMD, SMD and RHSMD (ratio of height to SMD) (89.2%, 75.7%, and 70.3%, respectively). Regarding difficult facemask ventilation, TMA showed greater sensitivity (86.7%) and SMD showed greater specificity (80%) compared to other anthropometric parameters. In a multivariate model, BMI (body mass index), COPUR (Colorado Pediatric Airway Score), BOV (best oropharyngeal view) and TMA were found to be independent predictors of difficult intubation, while BMI, ASA (The American Society Physical Status Classification System), CL (Cormack-Lehane Score), TMA and SMD predicted difficult facemask ventilation. Conclusions: Preoperative airway assessment is of great importance for ventilation and intubation. Patient's overall condition and facial measurements can be used as predictors of difficult intubation and ventilation.

Evaluation of preoperative difficult airway prediction methods for adult patients without obvious airway abnormalities: a systematic review and meta-analysis

BackgroundThis systematic review aims to assist clinical decision-making in selecting appropriate preoperative prediction methods for difficult tracheal intubation by identifying and synthesizing literature on these methods in adult patients undergoing all types of surgery.MethodsA systematic review and meta-analysis were conducted following PRISMA guidelines. Comprehensive electronic searches across multiple databases were completed on March 28, 2023. Two researchers independently screened, selected studies, and extracted data. A total of 227 articles representing 526 studies were included and evaluated for bias using the QUADAS-2 tool. Meta-Disc software computed pooled sensitivity (SEN), specificity (SPC), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Heterogeneity was assessed using the Spearman correlation coefficient, Cochran’s-Q, and I2 index, with meta-regression exploring sources of heterogeneity. Publication bias was evaluated using Deeks’ funnel plot.ResultsOut of 2906 articles retrieved, 227 met the inclusion criteria, encompassing a total of 686,089 patients. The review examined 11 methods for predicting difficult tracheal intubation, categorized into physical examination, multivariate scoring system, and imaging test. The modified Mallampati test (MMT) showed a SEN of 0.39 and SPC of 0.86, while the thyromental distance (TMD) had a SEN of 0.38 and SPC of 0.83. The upper lip bite test (ULBT) presented a SEN of 0.52 and SPC of 0.84. Multivariate scoring systems like LEMON and Wilson’s risk score demonstrated moderate sensitivity and specificity. Imaging tests, particularly ultrasound-based methods such as the distance from the skin to the epiglottis (US-DSE), exhibited higher sensitivity (0.80) and specificity (0.77). Significant heterogeneity was identified across studies, influenced by factors such as sample size and study design.ConclusionNo single preoperative prediction method shows clear superiority for predicting difficult tracheal intubation. The evidence supports a combined approach using multiple methods tailored to specific patient demographics and clinical contexts. Future research should focus on integrating advanced technologies like artificial intelligence and deep learning to improve predictive models. Standardizing testing procedures and establishing clear cut-off values are essential for enhancing prediction reliability and accuracy. Implementing a multi-modal predictive approach may reduce unanticipated difficult intubations, improving patient safety and outcomes.