Sivaraj, P (2015) Predictability of Difficult Laryngoscopy and Intubation using the Clinical and Radiological Imaging Study. Masters thesis, Chengalpattu Medical College, Chengalpattu.
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Abstract
BACKGROUND: Airway management is of prime importance to an anaesthesiologist. Unanticipated difficult laryngoscopy and endotracheal intubation remains a primary concern of anaesthesiologists. The reported incidence of a difficult laryngoscopy or endotracheal intubation varies from 1.5% to 13% in patients undergoing surgery. Failure to intubate is detected in 0.05 - 0.35% of the patients. Thus preoperative airway assessment is of pivotal importance for the anaesthesiologist to predict difficult intubation. Thus we aimed to study the usefulness of ten different airway assessment predictors as a clinical and radiological tool to predict difficult intubation. METHODS: Two hundred and eight patients between 15-75 years of age and either sex were included in our study. We assessed the clinical risk factors: modified Mallampati classification, mouth opening, thyromental distance, sternomental distance and Wilson’s risk score and radiologiocal risk factors : the atlantooccipital distance, cervical vertebra C-2 spine depth, effective mandibular length, anterior mandibular depth, posterior mandibular depth in all the patients. Patients with tumours or malformations of head and neck and oral cavity, edentulous patients, pregnancy and those requiring emergency surgeries were excluded. A Cormack Lehane grade of I & II were considered easy intubation and III & IV were considered to be difficult. RESULTS: Thirty eight patients had difficulty during intubation. The sensitivity and specificity of the clinical model were found to be, respectively, 97.2% and 95.3%. The sensitivity and specificity of the combined clinical and radiological model were found to be 100% and 95.3%, respectively. The area below the ROC curves, measures the probability of the correct prediction of the clinical and the combined models. It was found to be 0.992 and 0.993, respectively. This means that the clinical and combined models correctly predicted the outcome with a probability of 99.2% and 99.3%, respectively. CONCLUSION: From our study we found that, 1. Clinical models: modified Mallampati classification, sternomental distance, thyromental distance, interincissor gap and Wilson sum risk score, are important predictor of difficult intubation. 2. Radiological imaging- atlanto-occipital distance is also an important predictor of difficult laryngoscopy and intubation. 3. The other radiological predictors are of value when they are combined with clinical variables, but not as single predictor.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Predictability ; Difficult Laryngoscopy ; Intubation ; Clinical and Radiological Imaging Study. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Punitha K |
| Date Deposited: | 07 May 2018 05:12 |
| Last Modified: | 08 May 2018 02:27 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7597 |
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