Predictors of Difficult Intubation Among Malay Patients in Indonesia

Tantri, Aida Rosita; Firdaus, Riyadh; Salomo, Sahat Tumpal

doi:10.5812/aapm.34848

Cited by 13 publications

(10 citation statements)

References 14 publications

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“…). After detailed assessment, we included 133 studies (127 cohort type and six case–control) involving 844,206 participants . Of the 133 studies, there were six for the Mallampati test, 105 for the modified Mallampati test, six for Wilson risk score, 52 for thyromental distance, 18 for sternomental distance, 34 for the mouth opening test and 30 for the upper lip bite test.…”

Section: Resultsmentioning

confidence: 99%

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

et al. 2019

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Although bedside screening tests are routinely used to identify people at high risk of having a difficult airway, their clinical utility is unclear. We estimated the diagnostic accuracy of commonly used bedside examination tests for assessing the airway in adult patients without apparent anatomical abnormalities scheduled to undergo general anaesthesia. We searched for studies that reported our pre-specified bedside index screening tests against a reference standard, published in any language, from date of inception to 16 December 2016, in seven bibliographic databases. We included 133 studies (127 cohort type and 6 case-control) involving 844,206 participants. Overall, their methodological quality (according to QUADAS-2, a standard tool for assessing quality of diagnostic accuracy studies) was moderate to high. Our pre-specified tests were: the Mallampati test (6 studies); modified Mallampati test (105 studies); Wilson risk score (6 studies); thyromental distance (52 studies); sternomental distance (18 studies); mouth opening test (34 studies); and the upper lip bite test (30 studies). Difficult facemask ventilation, difficult laryngoscopy, difficult intubation and failed intubation were the reference standards in seven, 92, 50 and two studies, respectively. Across all reference standards, we found all index tests had relatively low sensitivities, with high variability, but specificities were consistently and markedly higher than sensitivities. For difficult laryngoscopy, the sensitivity and specificity (95%CI) of the upper lip bite test were 0.67 (0.45-0.83) and 0.92 (0.86-0.95), respectively; upper lip bite test sensitivity (95%CI) was significantly higher than that for the mouth opening test (0.22, 0.13-0.33; p < 0.001). For difficult tracheal intubation, the modified Mallampati test had a significantly higher sensitivity (95%CI) at 0.51 (0.40-0.61) compared with mouth opening (0.27, 0.16-0.41; p < 0.001) and thyromental distance (0.24, 0.12-0.43; p < 0.001). Although the upper lip bite test showed the most favourable diagnostic test accuracy properties, none of the common bedside screening tests is well suited for detecting unanticipated difficult airways, as many of them are missed.

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Section: Resultsmentioning

confidence: 99%

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

et al. 2019

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“…HMDR reflects the occipito-atlantoaxial complex extension capacity [3]. HMDR has been used to estimate the size of the submandibular space [7]. From this point of view, this might seem to be static, but it is actually a dynamic parameter, as the submandibular space expands during laryngoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Good sensitivity and specificity values were found by some authors 86.3-95.6% sensitivity and 69.2% specificity in non-obese patients [4,5]. Other studies confirmed moderate sensitivity of around 60% and lower specificity, suggesting that HMDR has little utility for difficult airway prediction [6,7]. A low sensitivity of 27.78% has also been reported for HMDR clin [8].…”

Section: Clinical Studiesmentioning

confidence: 93%

“…It was reported that a cutoff value of 1.2 discriminated between patients with difficult airways versus easy laryngoscopy [3]. The diagnostic accuracy of this parameter varied widely in subsequent studies, suggesting that evaluation of clinical parameters might be operator-dependent or that there might be difficulties regarding the palpation of the hyoid bone in certain patients [4][5][6][7][8]. In the last years, ultrasound measurements were applied for the hyomental distance ratio (HMDR echo ), also with variable sensitivity and specificity [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Clinical versus Ultrasound Measurements of Hyomental Distance Ratio for the Prediction of Difficult Airway in Patients with and without Morbid Obesity

et al. 2020

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Purpose: To describe the correlation between clinically measured hyomental distance ratio (HMDR clin ) and the ultrasound measurement (HMDR echo ) in patients with and without morbid obesity and to compare their diagnostic accuracy for difficult airway prediction. Methods: HMDR clin and HMDR echo were recorded the day before surgery in 160 consecutive consenting patients. Laryngoscopy was performed by a skilled anesthesiologist, with grades III and IV Cormack-Lehane being considered difficult views of the glottis. Linear regression was used to assess the correlation between HMDR clin and HDMR echo and receiver operating curve analysis was used to compare the performance of the two for predicting difficult airway. Results: The linear correlation between HMDR clin and HDMR echo in patients without morbid obesity had a Pearson coefficient of 0.494, while for patients with morbid obesity this was 0.14. A slightly higher area under the curve for HMDR echo was oberved: 0.64 (5%CI 0.56-0.71) versus 0.52 (95%CI, 0.44-0.60) (p = 0.34). Conclusion: The association between HMDR clin and HDMR echo is moderate in patients without morbid obesity, but negligible in morbidly obese patients. These might be explained by difficulties in palpating anatomical structures of the airway.

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“…These complications are highly detrimental and endanger the patient's life. Therefore, it is extremely important to avoid a failed intubation [2].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Endoscope Camera in Combination With Modified Standard Laryngoscope in Endotracheal Tube Installation

Hisam¹,

Ramadhan²,

Adhalina³

2021

Advances in Health Sciences Research

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Background: Emergency is a critical condition which requires accuracy and speed of actions. Intubation is one of the most frequently performed actions in an emergency department. The success of intubation has a significant influence on the success of the emergency department. A number of factors affect the success of intubation, including the technique of mastery of intubation. Laryngoscope is an important supporting instrument for intubation, which therefore requires expertise in its use. This study aimed to determine the effectiveness of a laryngoscope equipped with an endoscope camera. Methods: This study used a post-test only control group design as the experimental design. A total of 30 subjects acted as operators in the trial on intubation mannequins using a direct laryngoscope compared to using a laryngoscope equipped with an endoscope camera. Successful intubation was achieved when the insertion of an endotracheal tube right into the airway resulted in a chest expansion within a maximum of 120 seconds. The significance of the differences in the time and ease of use of video laryngoscopy was analyzed using SPSS version 24.0. Results: A stratified statistical analysis was carried out, starting with the Shapiro Wilk test to determine the normality of data distribution. The test indicated an abnormal distribution, thereby allowing the use of Wilcoxon test to determine the significance of the intubation time. No significant time difference was found in the use of laryngoscope versus laryngoscope equipped with an endoscope camera (p = 0.811). However, in the analysis using the Fisher Exact Test (p = 0.00) for the ease of use of laryngoscope equipped with an endoscope camera, significant results were obtained. Conclusion : The use of video laryngoscopy is not significant in terms of insertion time, but the ease of use analysis shows significant results.

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Predictors of Difficult Intubation Among Malay Patients in Indonesia

Cited by 13 publications

References 14 publications

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

Clinical versus Ultrasound Measurements of Hyomental Distance Ratio for the Prediction of Difficult Airway in Patients with and without Morbid Obesity

The Effectiveness of Endoscope Camera in Combination With Modified Standard Laryngoscope in Endotracheal Tube Installation

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