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Clinical Criteria for Airway Assessment: Correlations with Laryngoscopy and Endotracheal Intubation Conditions

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DOI: 10.4236/ojanes.2013.37070    7,012 Downloads   10,455 Views   Citations

ABSTRACT

Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a preanesthetic evaluation that may be capable of predicting a difficult intubation with the conditions encountered at laryngoscopy and endotracheal intubation. Eighty-one patients submitted to general anesthesia were evaluated at a preanesthetic consultation according to the modified Mallampati classification, the Wilson score and the American Society of Anesthesiologists (ASA) difficult airway algorithm. Findings were then correlated with the Cormack-Lehane classification and with the number of attempts at endotracheal intubation. No statistically significant correlations were found between the patients’ Mallampati classification and their Cormack-Lehane grade or between the Mallampati classification and the number of attempts required to achieve endotracheal intubation. Laryngoscopy proved difficult in four patients and in all of these cases the Wilson score had been indicative of a possibly difficult airway, highlighting its good predicting sensitivity. However, the specificity of this test was low, since another 24 patients had the same Wilson score but were classified as Cormack-Lehane I/II. Moreover, two patients who had a Wilson score ≥ 4 were also classified as Cormack-Lehane grade I/II. The study concluded that the Wilson score, although seldom used in clinical practice, is a highly sensitive predictor of a difficult airway; its specificity, however, is low.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

G. S. Wanderley, L. Lima, T. de Menezes Couceiro, W. Silva, R. G. A. Coelho, A. C. Lucena and A. Santos Soares, "Clinical Criteria for Airway Assessment: Correlations with Laryngoscopy and Endotracheal Intubation Conditions," Open Journal of Anesthesiology, Vol. 3 No. 7, 2013, pp. 320-325. doi: 10.4236/ojanes.2013.37070.

References

[1] S. R. Mallampati, S. P. Gatt, L. D. Gugino, S. P. Desai, B. Waraksa, D. Freiberger and P. L. Liu, “A Clinical Sign to Predict Difficult Endotracheal Intubation: A Prospective Study,” Canadian Anaesthetists’ Society Journal, Vol. 32, No. 4, 1985, pp. 429-434.
[2] G. L. Samsoon and J. R. Young, “Difficult Endotracheal Intubation: A Retrospective Study,” Anaesthesia, Vol. 42, No. 5, 1987, pp. 487-490. doi:10.1111/j.1365-2044.1987.tb04039.x
[3] T. Shiga, Z. Wajima, T. Inoue and A. Sakamoto, “Predicting Difficult Intubation in Apparently Normal Patients. A Meta-Analysis of Bedside Screening Test Performance,” Anesthesiology, Vol. 103, No. 2, 2005, pp. 429-437. doi:10.1097/00000542-200508000-00027
[4] L. H. Lundstrøm, M. Vester-Andersen, A. M. Møller, S. Charuluxananan, J. L’hermite and J. Wetterslev, “Poor Prognostic Value of the Modified Mallampati Score: A Meta-Analysis Involving 177 088 Patients,” British Journal of Anaesthesia, Vol. 107, No. 5, 2011, pp. 659-667. doi:10.1093/bja/aer292
[5] J. L. Apfelbaum, C. A. Hagberg, R. A. Caplan, C. D. Blitt, R. T. Connis, D. G. Nickinovich, C. A. Hagberg, R. A. Caplan, J. L. Benumof, F. A. Berry, C. D. Blitt, R. H. Bode, F. W. Cheney, R. T. Connis, O. F. Guidry, D. G. Nickinovich and A. Ovassapian, “Practice Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway,” Anesthesiology, Vol. 118, No. 2, 2013, pp. 251-270. doi:10.1097/ALN.0b013e31827773b2
[6] K. B. Greenland, M. J. Edwards and N. J. Hutton, “External Auditory Meatus-Sternal Notch Relationship in Adults in the Sniffing Position: A Magnetic Resonance Imaging Study,” British Journal of Anaesthesia, Vol. 104, No. 2, 2010, pp. 268-269. doi:10.1093/bja/aep390
[7] M. E. Wilson, D. Spiegelhalter, J. A. Robertson and P. Lesser, “Predicting Difficult Intubation,” British Journal of Anaesthesia, Vol. 61, No. 2, 1988, pp. 211-216. doi:10.1093/bja/61.2.211
[8] M. Adamus, S. Fritscherova, L. Hrabalek, T. Gabrhelik, J. Zapletalova and V. Janout, “Mallampati Test as a Predictor of Laryngoscopic View,” Biomedical Papers of the Medical Faculty of the University Palacky, Vol. 154, No. 4, 2010, pp. 339-344. doi:10.5507/bp.2010.051
[9] A. Lee, L. T. Fan, T. Gin, M. K. Karmakar and W. D. Ngan Kee, “A Systematic Review (Meta-Analysis) of the Accuracy of the Mallampati Tests to Predict the Difficult Airway,” Anesthesia and Analgesia, Vol. 102, No. 6, 2006, pp. 1867-1878. doi:10.1213/01.ane.0000217211.12232.55
[10] R. Domi, “A Comparison of Wilson Sum Score and Combination Mallampati, Tiromental and Sternomental Distances for Predicting Difficult Intubation,” Macedonian Journal of Medical Sciences, Vol. 2, No. 2, 2009, pp. 141-144. doi:10.3889/MJMS.1857-5773.2009.0045

  
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