Prediction of difficult tracheal intubation
Summary Background and objective: Preoperative bedside screening tests for difficult tracheal intubation may be neither sensitive nor specific enough for clinical use. The aim was to investigate if a combination of the Mallampati classification of the oropharyngeal view with either the thyromental o...
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| Veröffentlicht in: | European journal of anaesthesiology 2003-01, Vol.20 (1), p.31-36 |
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| creator | Iohom, G. Ronayne, M. Cunningham, A. J. |
| description | Summary Background and objective: Preoperative bedside screening tests for difficult tracheal intubation may be neither sensitive nor specific enough for clinical use. The aim was to investigate if a combination of the Mallampati classification of the oropharyngeal view with either the thyromental or sternomental distance measurement improved the predictive value. Methods: A total of 212 (109 male, 103 female) non-obstetric surgical patients, aged >18 yr, undergoing elective surgical procedures requiring tracheal intubation were assessed preoperatively with respect to the oropharyngeal (modified Mallampati) classification, thyromental and sternomental distances. An experienced anaesthetist, blinded to the preoperative airway assessment, performed laryngoscopy and graded the view according to Cormack and Lehane's classification. Results: Twenty tracheal intubations (9%) were difficult as defined by a Cormack and Lehane Grade 3 or 4, or the requirement for a bougie in patients with Cormack and Lehane Grade 2. Used alone, the Mallampati oropharyngeal view, and thyromental and sternomental distances were associated with poor sensitivity, specificity and positive predictive values. Combining the Mallampati Class III or IV with either a thyromental distance |
| doi_str_mv | 10.1017/S0265021503000061 |
| format | Article |
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J.</creator><creatorcontrib>Iohom, G. ; Ronayne, M. ; Cunningham, A. J.</creatorcontrib><description>Summary Background and objective: Preoperative bedside screening tests for difficult tracheal intubation may be neither sensitive nor specific enough for clinical use. The aim was to investigate if a combination of the Mallampati classification of the oropharyngeal view with either the thyromental or sternomental distance measurement improved the predictive value. Methods: A total of 212 (109 male, 103 female) non-obstetric surgical patients, aged >18 yr, undergoing elective surgical procedures requiring tracheal intubation were assessed preoperatively with respect to the oropharyngeal (modified Mallampati) classification, thyromental and sternomental distances. An experienced anaesthetist, blinded to the preoperative airway assessment, performed laryngoscopy and graded the view according to Cormack and Lehane's classification. Results: Twenty tracheal intubations (9%) were difficult as defined by a Cormack and Lehane Grade 3 or 4, or the requirement for a bougie in patients with Cormack and Lehane Grade 2. Used alone, the Mallampati oropharyngeal view, and thyromental and sternomental distances were associated with poor sensitivity, specificity and positive predictive values. Combining the Mallampati Class III or IV with either a thyromental distance <6.5 cm or a sternomental distance <12.5 cm decreased the sensitivity (from 40 to 25 and 20%, respectively), but maintained a negative predictive value of 93%. The specificity and positive predictive values increased from 89 and 27% respectively for Mallampati alone to 100%. Conclusions: The findings suggest that the Mallampati classification, in conjunction with measurement of the thyromental and sternomental distances, may be a useful routine screening test for preoperative prediction of difficult tracheal intubation.</description><identifier>ISSN: 0265-0215</identifier><identifier>EISSN: 1365-2346</identifier><identifier>DOI: 10.1017/S0265021503000061</identifier><identifier>PMID: 12553386</identifier><identifier>CODEN: EJANEG</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Anesthesia ; Anesthesia, General ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Female ; Frequency distribution ; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation ; Humans ; Intubation, Intratracheal ; Laryngoscopy ; Male ; Medical sciences ; Mortality ; Mouth - anatomy & histology ; Neck - anatomy & histology ; Original Article ; Oropharynx - anatomy & histology ; Patients ; Physical Examination ; Predictive Value of Tests ; Preoperative Care ; Prospective Studies ; Sensitivity and Specificity</subject><ispartof>European journal of anaesthesiology, 2003-01, Vol.20 (1), p.31-36</ispartof><rights>2003 European Society of Anaesthesiology</rights><rights>2004 INIST-CNRS</rights><rights>Copyright Cambridge University Press Jan 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c313t-78b10226d7861e28b46d95a623e43b2feb1d11c45ada927b3516290c9e35cb193</citedby><cites>FETCH-LOGICAL-c313t-78b10226d7861e28b46d95a623e43b2feb1d11c45ada927b3516290c9e35cb193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4024,27923,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15317192$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12553386$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Iohom, G.</creatorcontrib><creatorcontrib>Ronayne, M.</creatorcontrib><creatorcontrib>Cunningham, A. J.</creatorcontrib><title>Prediction of difficult tracheal intubation</title><title>European journal of anaesthesiology</title><addtitle>Eur J Anaesthesiol</addtitle><description>Summary Background and objective: Preoperative bedside screening tests for difficult tracheal intubation may be neither sensitive nor specific enough for clinical use. The aim was to investigate if a combination of the Mallampati classification of the oropharyngeal view with either the thyromental or sternomental distance measurement improved the predictive value. Methods: A total of 212 (109 male, 103 female) non-obstetric surgical patients, aged >18 yr, undergoing elective surgical procedures requiring tracheal intubation were assessed preoperatively with respect to the oropharyngeal (modified Mallampati) classification, thyromental and sternomental distances. An experienced anaesthetist, blinded to the preoperative airway assessment, performed laryngoscopy and graded the view according to Cormack and Lehane's classification. Results: Twenty tracheal intubations (9%) were difficult as defined by a Cormack and Lehane Grade 3 or 4, or the requirement for a bougie in patients with Cormack and Lehane Grade 2. Used alone, the Mallampati oropharyngeal view, and thyromental and sternomental distances were associated with poor sensitivity, specificity and positive predictive values. Combining the Mallampati Class III or IV with either a thyromental distance <6.5 cm or a sternomental distance <12.5 cm decreased the sensitivity (from 40 to 25 and 20%, respectively), but maintained a negative predictive value of 93%. The specificity and positive predictive values increased from 89 and 27% respectively for Mallampati alone to 100%. Conclusions: The findings suggest that the Mallampati classification, in conjunction with measurement of the thyromental and sternomental distances, may be a useful routine screening test for preoperative prediction of difficult tracheal intubation.</description><subject>Anesthesia</subject><subject>Anesthesia, General</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Female</subject><subject>Frequency distribution</subject><subject>General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation</subject><subject>Humans</subject><subject>Intubation, Intratracheal</subject><subject>Laryngoscopy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Mouth - anatomy & histology</subject><subject>Neck - anatomy & histology</subject><subject>Original Article</subject><subject>Oropharynx - anatomy & histology</subject><subject>Patients</subject><subject>Physical Examination</subject><subject>Predictive Value of Tests</subject><subject>Preoperative Care</subject><subject>Prospective Studies</subject><subject>Sensitivity and Specificity</subject><issn>0265-0215</issn><issn>1365-2346</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM1LxDAQxYMo7rr6B3iRIuhFqplJk7ZHWfyCBQX1XJI01Sz9WJP24H9vyhYWFOcyh_m9eY9HyCnQa6CQ3rxSFJwicMpoGAF7ZA5M8BhZIvbJfDzH431GjrxfB4QH3SGZAXLOWCbm5OrFmdLq3nZt1FVRaavK6qHuo95J_WlkHdm2H5QcgWNyUMnam5NpL8j7_d3b8jFePT88LW9XsWbA-jjNFFBEUaaZAIOZSkSZcymQmYQprIyCEkAnXJYyx1QxDgJzqnPDuFaQswW53P7duO5rML4vGuu1qWvZmm7wRYp5BhmjATz_Ba67wbUhW4EgBE0RMUCwhbTrvHemKjbONtJ9F0CLscbiT41BczY9HlRjyp1i6i0AFxMgvZZ15WSrrd9xnEEK-WjOJnPZKGfLD7OL-L_9D1tUhgo</recordid><startdate>200301</startdate><enddate>200301</enddate><creator>Iohom, G.</creator><creator>Ronayne, M.</creator><creator>Cunningham, A. J.</creator><general>Cambridge University Press</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>200301</creationdate><title>Prediction of difficult tracheal intubation</title><author>Iohom, G. ; Ronayne, M. ; Cunningham, A. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c313t-78b10226d7861e28b46d95a623e43b2feb1d11c45ada927b3516290c9e35cb193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Anesthesia</topic><topic>Anesthesia, General</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Female</topic><topic>Frequency distribution</topic><topic>General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation</topic><topic>Humans</topic><topic>Intubation, Intratracheal</topic><topic>Laryngoscopy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Mouth - anatomy & histology</topic><topic>Neck - anatomy & histology</topic><topic>Original Article</topic><topic>Oropharynx - anatomy & histology</topic><topic>Patients</topic><topic>Physical Examination</topic><topic>Predictive Value of Tests</topic><topic>Preoperative Care</topic><topic>Prospective Studies</topic><topic>Sensitivity and Specificity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Iohom, G.</creatorcontrib><creatorcontrib>Ronayne, M.</creatorcontrib><creatorcontrib>Cunningham, A. J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of anaesthesiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Iohom, G.</au><au>Ronayne, M.</au><au>Cunningham, A. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prediction of difficult tracheal intubation</atitle><jtitle>European journal of anaesthesiology</jtitle><addtitle>Eur J Anaesthesiol</addtitle><date>2003-01</date><risdate>2003</risdate><volume>20</volume><issue>1</issue><spage>31</spage><epage>36</epage><pages>31-36</pages><issn>0265-0215</issn><eissn>1365-2346</eissn><coden>EJANEG</coden><abstract>Summary Background and objective: Preoperative bedside screening tests for difficult tracheal intubation may be neither sensitive nor specific enough for clinical use. The aim was to investigate if a combination of the Mallampati classification of the oropharyngeal view with either the thyromental or sternomental distance measurement improved the predictive value. Methods: A total of 212 (109 male, 103 female) non-obstetric surgical patients, aged >18 yr, undergoing elective surgical procedures requiring tracheal intubation were assessed preoperatively with respect to the oropharyngeal (modified Mallampati) classification, thyromental and sternomental distances. An experienced anaesthetist, blinded to the preoperative airway assessment, performed laryngoscopy and graded the view according to Cormack and Lehane's classification. Results: Twenty tracheal intubations (9%) were difficult as defined by a Cormack and Lehane Grade 3 or 4, or the requirement for a bougie in patients with Cormack and Lehane Grade 2. Used alone, the Mallampati oropharyngeal view, and thyromental and sternomental distances were associated with poor sensitivity, specificity and positive predictive values. Combining the Mallampati Class III or IV with either a thyromental distance <6.5 cm or a sternomental distance <12.5 cm decreased the sensitivity (from 40 to 25 and 20%, respectively), but maintained a negative predictive value of 93%. The specificity and positive predictive values increased from 89 and 27% respectively for Mallampati alone to 100%. Conclusions: The findings suggest that the Mallampati classification, in conjunction with measurement of the thyromental and sternomental distances, may be a useful routine screening test for preoperative prediction of difficult tracheal intubation.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>12553386</pmid><doi>10.1017/S0265021503000061</doi><tpages>6</tpages></addata></record> |
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| subjects | Anesthesia Anesthesia, General Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Female Frequency distribution General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation Humans Intubation, Intratracheal Laryngoscopy Male Medical sciences Mortality Mouth - anatomy & histology Neck - anatomy & histology Original Article Oropharynx - anatomy & histology Patients Physical Examination Predictive Value of Tests Preoperative Care Prospective Studies Sensitivity and Specificity |
| title | Prediction of difficult tracheal intubation |
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