Thyromental Distance Research Articles

Evaluation of ratio of height to thyromental distance as a predictor of difficult visualization of larynx: A prospective observational single center study

BackgroundRatio of height to thyromental distance (RHTMD) is a relatively new predictor of difficult visualization of larynx (DVL). Studies on Indian population are limited and none is carried out in the northeastern part of India. AimsThe primary aim was to assess the performance of RHTMD as a predictor of DVL and compare its predictive performance with modified Mallampati test. The secondary aim was to compare the performance of RHTMD with sterno-mental distance, inter-incisor distance and upper-lip bite test, as a predictor of DVL. We also aimed to evaluate the performance of RHTMD as a predictor of Intubation difficulty scale (IDS) > 5. MethodsIn this prospective, observer blinded, single center study, adult patients of either sex scheduled to receive general anaesthesia with tracheal intubation were enrolled after permission from institutional committee. RHTMD, modified Mallampati test, sterno-mental distance, inter-incisor distance and upper-lip bite test wereassessed pre-operatively by a single examiner trained in the airway indices but not involved in laryngoscopy. On the day of surgery, laryngoscopy was performed by a trainee anaesthesiologist with minimum two years of experience who was blinded to the airway indices noted by the examiner preoperatively. The Cormack-Lehane grading and subsequent difficulty in intubation as per Intubation difficult scale was noted. RHTMD≥23.5, inter-incisor distance ≤ 4 cm, sterno-mental distance ≤12.5 cmand upper lip bite test class 3 were considered as predictor of difficult laryngoscopy. ResultsThe incidence of DVL and difficult intubation in our study was 6.57% (4.85 %-8.82%, 95% CI) and 1.37% (0.68%–2.7%, 95% CI) respectively. The sensitivity of RHTMD, modified Mallampati test, sterno-mental distance, inter-incisor distance and upper-lip bite test were 65.12%, 53.49%, 18.6%, 30.23% and 72.09% respectively. Specificity of RHTMD, modified Mallampati test, sterno-mental distance, inter-incisor distance and upper-lip bite test was 90.51%, 90.34%, 97.22%, 98.20%, and 89.69% respectively. Area under the ROC curve was highest for RHTMD (0.881). Area under the ROC curve for modified Mallampati test, sterno-mental distance, inter-incisor distance and upper-lip bite test was 0.742, 0.621, 0.757 and 0.815 respectively. RHTMD had a sensitivity, specificity, and AUC for predicting difficult intubation of 66.67%, 87.60%, and 0.908 respectively. ConclusionWe primarily conclude that RHTMD has a good predictive performance and is similar to modified Mallampati test as a predictor of difficult visualization of larynx. We secondarily conclude that RHTMD is a better predictor of difficult visualization of larynx compared to sterno-mental distance, inter-incisor distance and upper-lip bite test. It is also an excellent predictor of IDS> 5.

PREDICTION OF DIFFICULT INTUBATION USING MODIFIED MALLAMPATI TEST, STERNOMENTAL DISTANCE AND THYROMENTAL DISTANCE IN PATIENTS UNDER GOING GENERAL ANESTHESIA AT A TERTIARY CARE HOSPITAL

AIMS AND OBJECTIVES: To predict difcult intubation using modied mallampati test, sterno mental distance and thyromental distance in patients under going general anesthesia. Materials And Methods: A observational study done in department of anesthesia of a rural tertiary hospital, kuppam, india. All Patients undergoing elective major surgeries under general anesthesia with cuffed oral endotracheal tube, in pes hospital, kuppam. Patients undergoing el INCLUSION CRITERIA: ective surgery under general anesthesia. Patients of either gender between age of 18 years and 65 years. ASA grade 1 and 2. Emergency EXCLUSION CRITERIA: surgeries. ASA grade 3 and 4. Pregnant patients. Body Mass Index more than 30.Patients with known abnormalities or obvious malformations of the airway, with head or neck trauma, edentulous patients. Three hundred and ve A Results: SA 1 and ASA 2 patients in the age group 18– 65 years scheduled for elective surgical procedures requiring endotracheal intubation were included in the study.Out of the 305 patients included in the study, 174 were females (57%) and 131 were males (43%). The mean age group was 38.4 +/-8.8 years (Mean + SD). Difcult laryngoscopy was seen in 27 patients (8.9%). Failed intubation was encountered in none of these patients. we concluded that Efcacy of Conclusion: combining MMT, SMD and TMD is also signicantly higher than any single test.

Importance of Neck Circumference to Thyromental Distance Ratio: A Preoperative Bedscreening Test Characterizing the Complexity of Endotracheal Intubation in Obese Patients

Importance of Neck Circumference to Thyromental Distance Ratio: A Preoperative Bedscreening Test Characterizing the Complexity of Endotracheal Intubation in Obese Patients

Clinical and ultrasonographic assessment of airway indices among non-pregnant, normotensive pregnant and pre-eclamptic patients: a prospective observational study

BackgroundPrediction of a difficult airway is of paramount importance for an anaesthesiologist. Various anatomical and physiological factors contribute to a difficult airway in pregnant females, especially those with pre-eclampsia. The aim of the study was to assess airway indices using both routinely used clinical methods and ultrasound. MethodsFifty-five non-pregnant females, 55 normotensive pregnant females and 55 females with pre-eclampsia were included in this prospective study. Clinical airway assessment was the modified Mallampati score, thyromental distance, hyomental distance, hyomental distance ratio, chest circumference, neck circumference and chest-to-neck circumference ratio. Sonographic assessment included tongue width, tongue volume, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, subglottic diameter, ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds. ResultsSeveral significant differences were observed between pregnant and non-pregnant females, with additional changes in pre-eclamptic females. These included clinical parameters such as the modified Mallampati score and sonographic measurements of tongue width, tongue volume, subglottic diameter, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, and the ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds. ConclusionRoutinely used clinical methods of airway assessment lack sensitivity and specificity. Ultrasound can visualise anatomical structures in the supraglottic and subglottic views and is encouraging as an airway assessment tool.

Validation of Modified Mallampati Test with Addition of Thyromental Distance and Sternomental Distance to Predict Difficult Endotracheal Intubation in Adults Presenting in Surgical Emergency

Objective: To validate modified mallampati test with addition of thyromental distance and sternomental distance in prediction of difficult endotracheal intubation in adults presenting in surgical emergency. Study Deign: Prospective, single-blinded observational study Place and duration: Department of Anesthesia and intensive care Nishtar Hospital, Multan from August 2021 to January 2022 in one year duration. Methodology: A total of 120 patients were included in the study. Difficult intubation was predicted by measuring modified mallampati test following thyromental distance and sternomental distance. Validation of mallampati test and combining predictors was assessed by measuring sensitivity, specificity, positive & negative predictive value. Contingency table 2x2was designed. Results: The sensitivity and specificity of this procedure was 62.5% and 80.0%, respectively. Validity of combining all parameters to predict the difficult in endotracheal intubation was shown in table IV. The sensitivity and specificity of this procedure was 25.0% and 27.0%, respectively. Practical Implication: Endotracheal intubation is a common pre-operative complication having potential to lead poor post operative results. This study will help the anesthesiologists to overcome the problem of intubation and reduce the incidence of post operative complications in routine practice. Conclusion: Specificity of modified mallampati is too high, validity of combine parameters modified mallampati, sternomental distance and thyromental distance is very high when compared with mallampati test alone. All three parameters MMT, SMD and TMD can be used collectively for assessment of difficult airway in adult patients planned for surgery under general anesthesia. Keywords: Validity, anaesthesia, modified Mallampati test, endotracheal intubation, thyromental distance, sternomental distance

Evaluation of Palm Print Sign and Prayer Sign in Prediction of Difficult Laryngoscopy in Diabetic Patients.

Laryngoscopy or endotracheal intubation in diabetic patients due to impaired mobility of the Atlanto-occipital joint owing to non-enzymatic glycosylation in connective tissue has always been a problem. A difficult laryngoscopy can disrupt the intubation process; therefore, it is valuable to predict difficult laryngoscopy using some anatomical criteria before general anesthesia. The present study discussed the diagnostic value of two tests, palm print sign and prayer sign, in the prediction of laryngoscopy difficulty. Design: A diagnostic test and cross-sectional analytical design were used in this study. Setting: The study population included 200 patients with type 2 diabetes who were candidates for surgery under general anesthesia. Before surgery, the patients were examined regarding the airway status, Mallampati classification, head extension rate, thyromental distance, body mass index, upper lip biting test, and two palm print sign and prayer sign tests. All the diagnostic tests were compared to the Cormack test result for difficult airways regarding their sensitivity and specificity in difficult laryngoscopy. The highest sensitivity was related to the Mallampati test, prayer sign test, and palm print sign test (100%). Furthermore, the mouth-opening test had the highest specificity (100%). The highest accuracy was reported for Mallampati, palm print sign, and prayer sign tests (> 86%). Among the tests studied to predict difficulty in laryngoscopy in diabetic patients, Mallampati and palm print sign tests have good sensitivity, specificity, and accuracy. Studies with a larger sample size are suggested to obtain more accurate results.

Prediction of Difficult Endotracheal Intubation by Different Bedside Tests

Background: An incidence of difficult intubation in elective surgery is 1.5%–8%. Multiple attempts during tracheal intubation can cause airway injuries bleeding, brain hypoxia, and even cardiac arrest. Unanticipated failure and inability to secure difficult airway can lead to “cannot ventilate, cannot intubate” condition. Preoperative assessment and bedside tests play a vital role in predicting and stratifying risk of difficult intubation. This study was done to determine the incidence of difficult intubation and diagnostic accuracy of different bedside tests for predicting intubation difficulty in patients without airway pathology scheduled for elective surgery under general anesthesia. Materials and Methods: Two hundred patients, aged 20–50 years, American Society of Anaesthesiologists I and II, without airway pathology undergoing elective surgery were evaluated preoperatively using simple bedside tests such as Mallampati grading (MPG), interincisor gap (IIG), thyromental distance (TMD), sternomental distance, upper lip bite test, neck circumference, and atlantooccipital extension to predict difficult intubation. Statistical confirmation was done using Pearson’s chi-square test and univariate and multivariate logistic regression. Results: In our study, the incidence of difficult intubation was observed as 6%. High sensitivity for predicting difficult intubation was seen with IIG > TMD > MPG, and high specificity among the relevant bedside tests was seen with TMD > MPG > IIG. Tests with high positive predictive value were TMD > MPG, whereas high negative predictive value was seen with IIG > TMD >MPG. Conclusion: IIG, TMD, and MPG can be used to predict difficult intubation in patients without airway pathology.

Anthropometry of thyromental distance of adult Ibibios and Annangs in Akwa Ibom State, Nigeria

The thyromental distance (TMD) is defined as the distance from the thyroid notch to mental prominence with the head fully extended. The objective of this study was to investigate thyromental distance among adults of Ibibio and Annang Ethnic groups of southern Nigeria. A total of 600 volunteers consisting of 313 (52.2%) males and 287 (47.8%) females, aged between 21-50 years were measured. Annang males and females had higher thyromental distance of (7.27 ± 0.06 cm; 6.91±0.05 cm) compared to the Ibibio males and females (7.13±0.06cm; 6.82±0.05 cm), respectively. The mean thyromental distance of the Annang subjects was significantly higher at p˂ 0.03 than that of the Ibibio adults. In most cases the highest mean thyromental distance was recorded within the 31-40 years age range.

Predicting Difficult Laryngoscopy by Ultrasound Quantification of Anterior Neck Soft Tissue Thickness-A Prospective Observational Study

Introduction: Difficult airway can possess a challenge to intubation and deciding role in morbidity and mortality. Hence, at these times Ultrasonography (USG) can play a vital role in the prediction of a difficult airway. Aim: To determine if USG measurement of anterior neck soft tissue thickness at the hyoid bone, and anterior commissure levels can be used to predict difficult laryngoscopy. Materials and Methods: The prospective observational study was carried out from January 2021-January 2022. There were 50 patients, aged 20-60 years, and scheduled to undergo general anaesthesia. Correlation analysis between roles of screening tests like Mallampati scoring (MMP), Cormack Lehane (CL) grade Neck Circumference (NC), Thyromental Distance (TMD) and USG measurements was done for predicting difficult laryngoscopy. Portable USG machine with a linear frequency probe, measuring tape and laryngoscope blade was required. The data was analysed using Statistical Package for Social Sciences (SPSS) version 22. Results: The incidence of difficult laryngoscopy was 18% and the mean age of the study participants in the easy group was 44.26 years and in the difficult group it was 45.13 years. The USG measurements were significant (p-value=0.01) in determining difficult intubation, which shows greater validity to predict difficult laryngoscopy. Hence, USG measurement along with bedside screening test aids in better identification and assessment of difficult airway. Conclusion: Anterior neck soft tissue thickness measured by USG at the hyoid bone, and anterior commissure levels combined with the screening tests and risk factors might increase the ability to predict difficult airways.

Comparison of the Hemodynamic Effects of Intubation via Fastrach Laryngeal Mask Airway with Standard Direct Laryngoscopy in Hypertensive Patients

Background/Aim: In this study, hemodynamic response and postoperative complications of intubation via laryngoscopy compared to laryngeal mask airway were investigated in hypertensive patients. Materials and Methods: Following ethics committee approval, 120 ASA II-III patients (aged 18-65 years) with stage 1 or 2 hypertension who required endotracheal intubation in an elective surgery were randomly assigned into 2 groups. Group L (n = 60) was defined as the direct laryngoscopy in endotracheal intubation group, and Group F (n = 60) used the Fastrach LMA in endotracheal intubation. The HR, SAP, DAP, MAP and SpO2 were recorded at baseline (after premedication by midazolam), after anesthesia induction (when no response was recorded to TOF stimulation), during intubation, and on minutes 0, 1, 2, 3, 4 and 5 after intubation. The patients were transferred to the recovery room after extubation. Patients were asked at the postoperative 30th minute whether they experienced a sore throat or hoarseness. To check pharyngolaryngeal morbidity, sore throat and hoarseness were assessed by a 4-point scale. Results: Demographic characteristics were found to be similar in both groups. Thyromental and sternomental distance and difficulties in mask ventilation were found to be similar. It was found that time to intubation was significantly higher in group F. In group L, the HR, DAP and MAP values increased on minute 0 after intubation when compared to the baseline values and returned to baseline values within one minute. In group F, the HR, SAP, DAP and MAP decreased on minute 0 compared to the baseline. Postoperative morbidity was comparable between the groups. No significant difference was found in sore throat and hoarseness between the groups. Conclusion: Intubation via LMA is more advantageous in alleviating hemodynamic responses. Intubation via direct laryngoscopy is a more rapid method when compared to intubation via LMA. There was no significant difference in upper respiratory tract morbidity between the groups.

Analysis of various airway evaluation tests to prognosticate difficult endotracheal intubation

Background: Unanticipated difficult intubation or failure of intubation is a major source for anesthesia associated deaths. Hence pre-anesthetic checkup should include a detailed airway evaluation to foresee difficult endotracheal intubation. Some easy bedside tests to predict difficult airway include modified Mallampati test (MMT), ratio of height to thyromental distance (RHTMD), and upper lip bite test (ULBT). Actual difficulty of airway can be estimated using Cormack Lehane (CL) grading while performing laryngoscopy. Combination of two or more bedside clinical tests is used to identify difficult airway and act accordingly. Aims and Objectives: We aimed at identifying those airway assessment tests which best predicted difficult airway. The objectives were to determine the agreement between MMT, RHTMD, ULBT with CL grading, and also the agreement between MMT and ULBT, MMT and RHTMD. Materials and Methods: This observational research was done in 88 individuals between 18 and 75 years planned for elective procedures requiring endotracheal intubation as a part of general anesthesia. The clinical assessment tests such as ULBT, RHTMD, and MMT were done on eligible participants during pre-anesthetic check-up. In the operation theater, patient was prepared, premedicated, and induced. CL grading was used to assess the laryngoscopic view. We tried to determine the agreement between MMT, ULBT and RHTMD with CL grading. We also tried to determine the agreement between MMT and ULBT., MMT and RHTMD. Results: MMT showed moderate, RHTMD showed slight, and ULBT showed no agreement with CL grading. MMT showed highest sensitivity and RHTMD showed highest specificity. No agreement was found for ULBT and RHTMD with MMT. Conclusion: MMT and RHTMD can be used in predicting difficult airway access; out of which MMT is better than RHTMD. ULBT is not an ideal test to identify difficult endotracheal intubation. Laryngoscopic view becomes difficult with increase in weight and age.

Difficult Airway Anthropometric Measurements in Patients with Obstructive Sleep Apnea According to Sleep Endoscopy Scores

Aim: The aim of the study was to determine the measures to evaluate difficult intubation and predictors of intubation difficulties in the preoperative period in patients undergoing obstructive sleep apnea syndrome (OSAS) surgery. With these measurements, both the modified Cormack Lehane score and obstructions during sleep endoscopy were evaluated. 
 Material Methods: The study included 40 patients who presented at the outpatient clinic with the complaint of snoring, underwent polysomnography, and were diagnosed with OSAS between August 2018 and December 2019. Measurements were taken of the modified Mallampati Index, mouth opening, thyromental distance, and sternomental distance. The modified Cormack Lehane scoring system was applied after anesthesia induction.
 
 Results: A statistically significant correlation was observed between thyromental distance and the Modified Cormack Lehane Scoring-system (MCLS) (p = 0.017) and between intubation time and MCLS (p = 0.012). As MCLS increased, the average intubation time increased. A statistically significant correlation was observed between external compression and MCLS (p = 0.001) and between the number of intubation trials and MCLS (p = 0.035). A positive correlation was found between MCLS and the desaturation index (p = 0.035, r = 0.343) and between the MCLS and the hypopnea index (p = 0.031, r = 0.342)
 Conclusion: There was found to be interdependence with the measurements related to difficult intubation according to both the sleep position and the apnea hypopnea index and hypopnea index

Thyromental height test as a predictor of difficult airway. Single test versus multivariate predictive models. A cohort study

ABSTRACT Background Thyromental height test (TMHT) revealed good potential to predict difficult airway but with variable cut-off values. This study aimed to assess the validity of TMHT either as a sole test or within multivariable models for predicting difficult airway. Methods The study included 612 patients aged ≥18 years who were scheduled for elective surgeries under general anaesthesia with an endotracheal tube. Airway was assessed with TMHT, Thyromental distance (TMD), Sternomental distance (SMD), inter-incisor distance (IID), and Modified Mallampati test (MMT). The difficult laryngoscopy (DL) was defined as Cormack–Lehane (C-L) grade > 2. The primary outcome was the validity of TMHT as a predictor for DL. Results Cases with DL were 56 (9.2%) patients, while cases with difficult intubation (DI) were 7 (1.1%). The TMHT was significantly shorter in cases with DL compared to easy laryngoscopy (45.82 ± 8.21 versus 56.93 ± 8.83 mm, respectively) and in cases with DI compared to easy intubation (42 ± 7.19 versus 56.07 ± 9.24 mm respectively). TMHT was a good predictor for both DL and DI at a cut-off value of ≤ 48 mm with an AUROC (Area Under the Receiver Operating Characteristic) curve of 0.82 (95% CI: 0.79 to 0.85) and 0.89 (95% CI: 0.82 to 0.92), respectively. The logistic regression analysis incorporated the TMHT within two multivariable predictive models for DL and DI with better predictive ability. Conclusion In adult surgical patients, TMHT is a good objective predictor for DL and DI. The predictive ability increased when incorporated into two multivariable models. Trial registration ClinicalTrials.gov, ID: NCT04264338 in February 2020.

COMPARISON OF PREOPERATIVE AIRWAY INDICES, BODY MASS INDEX (BMI), WITH INTRA-OPERATIVE VISUALISATION OF VOCAL CORDS AND DIFFICULTY WITH MASK VENTILATION AND INTUBATION IN SNORERS AND NON SNORERS

Introduction : Prediction of difcult intubation before induction of anaesthesia is not easy but very important. 'Difcult airway' is a clinical situation where there is difculty in establishing or maintaining gas exchange via a mask, an articial airway or both by a conventionally trained anaesthesiologist.Here we focussed on the utility of individual upper airway evaluation by physical examination and its usefulness in predicting a difcult airway among people who snore. Aim: Ÿ To Compare Airway Indices, Body Mass Index (BMI), Cormack - Lehane Grading and Difculty with Mask Ventilation and Intubation Ÿ To determine the most reliable single parameter in identifying difcult airway. Methods: After obtaining approval from institutional ethics committee and written informed consent from the patients between 18 and 60yrs of age, of either sex, requiring general anaesthesia with endotracheal intubation for elective procedures the following anatomical markers are measured -Mouth opening (inter incisor distance), Modied MallampatiScore (MMPT), Thyromental distance (TMD), Neck circumference, Neck extension, Thyomental height, Cormack lehane's grading. Cormack lehane grades I, II were dened as easy visualization of larynx (EVL) and predict easy intubation.Grades III and IV were dened as difculty in visualization of larynx (DVL) and predict difcult intubation. Data Entry was done using Microsoft excel 2013 and analysis done using SPSS V 16. Qualitative data was expressed in frequencies and percentages and Quantitative data in mean and standard deviation .p value of <0.05 was considered statistically signicant.

EVALUATION OF AIRWAY INDICES FOR PREDICTING DIFFICULTY IN ENDOTRACHEAL INTUBATION IN PATIENTS WITH DIABETES MELLITUS

Background:The need to predict potentially difcult tracheal intubation has received more importance but with limited success. The present study was conducted to assess various airway evaluation indices used to predict difcult airway in Indian patients with diabetes mellitus. Methods: This prospective, observational study was carried out in 85 patients at a tertiary care hospital in Western India. All patients underwent thorough airway assessment using modied Mallampati classication, mouth opening, upper lip bite test, thyromental distance, head extension, palm print, prayer sign and body mass index. Preoperative data of the various airway indices were co-related with difcult intubation to evaluate the sensitivity, specicity, positive predictive value and negative predictive value of each test. Results: Overall, the best indicator to predict difcult intubation in patients with diabetes was the palm print (58.7% sensitive; 94.9% specic; 75.3% accurate) followed by Mallampati score (50% sensitive; 94.9% specic; 70.6% accurate) and prayer sign (54.3% sensitive; 89.7% specic; 70.6% accurate). There was a signicant association between prediction of difcult intubation and occurrence of complications during intubation in patients with diabetes. Conclusion: Even though all airway indices have their place in an anesthesiologists' armamentarium, the palm print is an ideal predictor of difcult intubation in patients with diabetes, followed by the Mallampati score and the prayer sign.

Predictive values of the modified Mallampati test, upper lip bite test, thyromental distance and ratio of height to thyromental distance to predict difficult laryngoscopy in pediatric elective surgical patients 5–12 years old at selected Addis Ababa governmental hospitals, Ethiopia: a multicenter cross-sectional study

BackgroundMaintaining patent airways is vital in pediatric anesthetic management. Failure to manage and anticipate difficult laryngoscopy (DL) preoperatively is the leading cause of morbidity and mortality. Data on the predictive values of screening parameters in predicting DL are limited in children. Therefore, this study aimed to assess the predictive value of the modified Mallampati test (MMT), upper lip bite test (ULBT), thyromental distance (TMD), and ratio of height to thyromental distance (RHTMD) in predicting DL in children aged 5–12 years at selected Addis Ababa governmental hospitals in Ethiopia.MethodsA multicenter cross-sectional study was conducted on 141 elective pediatric surgical patients aged 5 to 12 years selected using a systematic random sampling technique at three governmental hospitals from December 1, 2021, to April 30, 2022. The collected data were entered and analysed by SPSS version 26. Chi-square and Fisher’s exact tests were used to compare categorical variables. The receiver operating characteristic curve analysis was used to compare the accuracy of MMT, ULBT, TMD, and RHTMD against DL. A P value < 0.05 was considered statistically significant.ResultsThe magnitude of DL was 15.6%. MMT has the highest sensitivity (86.4%), specificity (91.6%), and negative predictive value (NPV) (97.3%) compared to other tests. The ULBT also has a high sensitivity (72.7%) and specificity (84%) with comparable diagnostic accuracy (90.8%) with the MMT (P < 0.05). The sensitivity, specificity, positive predictive value (PPV), NPV, and accuracy of TMD were 63.6%, 95.8%, 73.7%, 93.4%, and 82.2%, respectively. The RHTMD has the lowest specificity (63.6%), PPV (22.5%), NPV (91.4%), and accuracy (56.7%) in predicting DL.ConclusionThe MMT and ULBT are good screening tests, followed by the TMD in predicting DL, while the RHTMD was the least accurate predictor. Because no single test has 100% predictive value, a combination of screening tests is advised in pediatrics for predicting DL.

Difficult airway management in an emergency in Nepal

Introduction: Health care provider often face challenges in managing airway in-patients in emergency department having respiratory compromise. Here in this review, we have discussed advances in management of difficult airway in emergency setting in Nepal.&#x0D; Method: Articles available n google scholar with key word “ airway management’’, “difficult airway” , “ emergency” , “failed intubation”, “ Nepal” were retrieved. Amongst which 14 articles were retrieved for the discussion.&#x0D; Result: MMT was better for predicting difficult laryngoscopy when compared to measurement of sternomental, thyromental and inter-incisor distances and grading of mandibular protrusion. Similarly when comparing upper lip bite test to MMT, ULBT has better sensitivity and specificity. laryngoscopic view with 5 cm of head elevation had a better visualization.&#x0D; Conclusion: The available evidence recommend using upper lip bite test in emergency setting with comparison to modified / mallampati classification. Different tests can be used in accordance to urgency of intervention. Similarly, head elevation of 5 cm can be routinely practiced for better visualization during laryngoscopy.

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

Measurement of Neck Circumference, Tongue thickness and Skin to Epiglottis Distance as Predictors of Difficult Intubation: A Prospective Study

Airway Assessment is essential in pre anesthetic assessment. Anticipating and preparing for difficulty in airway management is crucial to avoid airway catastrophes. Routine pre operative airway examination usually includes mouth opening and dentition, Mallampati classification, thyromental distance and neck movements. Neck circumference is a quick bedside test to determine difficult laryngoscopy. Increased tongue thickness and skin to epiglottis distance affects performance of laryngoscopy and tracheal intubation increasing the risk of difficult airway. Presently there is a search for non-invasive and accurate tools to overcome limitations of clinical airway assessment tests. Ultrasonography has been evolving as a useful device for airway assessment especially soft tissue structures in anterior surface of neck. Here we studied the measurement of neck circumference and ultrasound measurement of tonguethickness and skin to epiglottis distance as predictors for difficult intubation. The Aim of the study is to predict difficulty in intubation by measuring neck circumference, thickness of tongue and thickness of skin to epiglottis. Prospective observational study, 120 patients posted for surgery under general anesthesia, Department of anesthesia, Meenakshi medical college, Kanchipuram. After institutional Human ethical committee clearance, 120 Patients were screened during preoperative assessment for undergoing procedures under general anaesthesia. Neck circumference and other airway parameters were measured with measuring tape and distance between Skin to epiglottis and tongue thickness were measured with ultrasound linear probe. Patients were grouped into Group E( Easy Intubation) whose Cormack-lehane grade was 1 and 2 and Group D ( Difficult intubation) whose Cormack-lehane grade was 3 and 4. SPSS version 16 was used for statistical analysis. There was no statistical significance seen between age, sex, height among easy and difficult intubation but significance was seen with weight (p &lt;0.05), Thyromental distance(p&lt;0.05) and Sterno-mental distance(p&lt;0.05). High significance was seen in Distance between skin to epiglottis distance(p&lt;0.001), Tongue thickness(p&lt;0.001) and Neck Circumference(p&lt;0.001) in difficult intubation cases. Neck circumference and ultrasonographic measurement of tongue thickness and skin to epiglottis can avoid unanticipated difficult intubation.

A Comparison of the Effectiveness of Videolaryngoscopy and Macintosh Laryngoscopy in Intubation Attempts on Adult Patients.

This study aimed to compare the effectiveness of videolaryngoscopy and Macintosh laryngoscopy on adult patients who were scheduled for elective surgery under general anaesthesia. Of the 200 adult patients who were scheduled to undergo general anaesthesia, 100 were intubated with a videolaryngoscope and 100 with a Macintosh laryngoscope. The patients' age, sex, American Society of Anesthesiologists score, height, weight, body mass index, smoking and alcohol habits, comorbidity, and neck circumference were recorded. Their El-Ganzouri Risk Index score, which considers the parameters of mouth opening, thyromental distance, Mallampati score, neck movement, propensity for prognathism, body weight, and history of difficult intubation, was also calculated and recorded. The time to achieve intubation was then recorded. The number of intubation attempts, number of cases of difficult intubation, Cormack-Lehane scores, and incidences of trauma or complication were also evaluated. The mean intubation time was found to be significantly lower in the videolaryngoscope group compared to the Macintosh laryngoscope group. Although the number of patients with difficult intubation was high in the videolaryngoscope group, when we evaluated their glottic view, the Cormack-Lehane score was found to be significantly lower. The number and ratio of complications due to intubation were lower in the videolaryngoscope group compared to the Macintosh laryngoscopy group. In patients undergoing endotracheal intubation for general anaesthesia, it was concluded that videolaryngoscopy is superior to Macintosh laryngoscopy as it enlarges the glottic view, shortens the time to achieve intubation, facilitates intubation, and has less risk of complications.