Sex-Specific Intubation Biomechanics: Intubation Forces Are Greater in Male Than in Female Patients, Independent of Body Weight

Hindman, Bradley J.; Dexter, Franklin; Gadomski, Benjamin C.; Bucx, M. J. L.

doi:10.7759/cureus.8749

Cited by 4 publications

(6 citation statements)

References 29 publications

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“…Studies on the correlation between gender and difficult airway found that difficult airway is encountered more commonly in males than females. [24] In our study, we found a slight increase in difficult airway among male patients, which agrees with the literature (p<0.05). The cervical vertebra, muscle, and soft-tissue volume are larger in men than women, even after adjusting for various body sizes, including total body weight.…”

Section: Discussionsupporting

confidence: 93%

The use of STOPBANG questionnaire and other difficult airway determinants in difficult airway prediction and correlation.

Bilge¹

2021

Ulus Travma Acil Cerrahi Derg

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The use of STOP-BANG questionnaire and other difficult airway determinants in difficult airway prediction and correlation ficult tracheal intubation. Therefore, in patients under anesthesia, difficult facemask ventilation is also a critical situation to be resolved as with failed intubation.Obstructive sleep apnea syndrome (OSAS) is a cautionary predictor of difficult airway. OSAS is a disorder characterized by obstructive apnea and hypopnea episodes during sleep and excessive daytime sleepiness. Polysomnography is the gold standard in the diagnosis of this disorder. [3] However, the STOP-BANG questionnaire is the preferred screening

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Section: Discussionsupporting

confidence: 93%

The use of STOPBANG questionnaire and other difficult airway determinants in difficult airway prediction and correlation.

Bilge¹

2021

Ulus Travma Acil Cerrahi Derg

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“…This finding is likely related to reduce upper airway size and increased Mallampati score and laryngoscopy grade in older population [ 39 , 40 ]. Although male sex is associated with higher Mallampati score [ 40 ], upper airway collapsibility [ 39 ], and intubation forces [ 41 ], our analysis showed higher percentage of males correlated with increased rate of successful intubation and reduced rate of adverse events. Females have different upper airway anatomy, physiology, and biomechanics compared to males [ 39 , 41 – 43 ].…”

Section: Discussionmentioning

confidence: 87%

A Systematic Review and Meta-Analysis of Randomized Controlled Trials on Supine vs. Nonsupine Endotracheal Intubation

Palma

Mashina

Chen

et al. 2023

Critical Care Research and Practice

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Background. This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to compare the safety and efficacy of supine vs. nonsupine positions during intubation. Methods. Based on the literature from inception to October 2020, 13 studies with nonemergent intubation in supine and nonsupine positions were chosen using PRISMA and MOOSE protocols. Pooled estimates were calculated using random-effects models with 95% confidence interval (CI). The primary outcome was a successful intubation, attempt, and duration of intubation. The secondary outcome was adverse events (trauma and hypoxia). Bias was evaluated qualitatively, by visual analysis, and quantitatively through the Egger test. Results. The final analysis included 13 clinical trials with 1,916 patients. The pooled success rates in the supine vs. lateral positions were 99.21% and 98.82%. The supine vs. semierect positions were 99.21% and 98.82%. The 1st attempt success rate in the supine vs. lateral position was 85.35% and 88.56% compared to 91.38% and 90.76% for the supine vs. semierect position. The rate of total adverse events in the supine position was 3.73% vs. 6.74% in the lateral position, and the rate of total adverse events in the supine position was 0.44% vs. 0.93% in semierect position. Low to substantial heterogeneity was noted in our analysis. Discussion. There is no significant difference between total successful intubations and success from 1st intubation attempt between supine and nonsupine positions. However, there are slightly higher rates of adverse events in nonsupine position. Addition of more recent studies on supine vs. nonsupine intubations would improve this study. Given these findings, it is important to develop more studies regarding different intubation positions and techniques with the aim of improving efficacy and decreasing adverse outcomes. Other. This review is not registered in a public database. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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“…The 4-parameter linear regression model included the common intercept and 3 factors: laryngoscope (binary variable [Macintosh 1 and Airtraq 0]), percent glottic opening (continuous variable), and their interaction (the main factor of interest). For estimation of parameters, in our previous study of maximum intubation forces, 6 there were 3 of 101 observations that were mild outliers, exceeding the upper inner fence, and 1 of 101 extreme outliers, exceeding the outer inner fence. b Therefore, as done in the earlier study, 6 both least-squares linear regression and robust regression were used, the latter to account for outliers.…”

Section: Methodsmentioning

confidence: 98%

“…For estimation of parameters, in our previous study of maximum intubation forces, 6 there were 3 of 101 observations that were mild outliers, exceeding the upper inner fence, and 1 of 101 extreme outliers, exceeding the outer inner fence. b Therefore, as done in the earlier study, 6 both least-squares linear regression and robust regression were used, the latter to account for outliers. If the sample size was large, robust regression would be more suitable than least-squares regression because of the outliers.…”

Section: Methodsmentioning

confidence: 98%

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Relationship Between Glottic View and Intubation Force During Macintosh and Airtraq Laryngoscopy and Intubation

Hindman

Dexter

Gadomski

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Because intubation-mediated cervical spine and spinal cord injury are likely determined by intubation force magnitude, understanding the determinants of intubation force magnitude is clinically relevant. With direct (Macintosh) laryngoscopy, when glottic view is less favorable, anesthesiologists apply greater force. We hypothesized that, when compared with direct (Macintosh) laryngoscopy, intubation force with an optical indirect laryngoscope (Airtraq) would be less dependent on glottic visualization. METHODS: Using data obtained in a prior clinical study, we tested whether the slope of the intubation force versus glottic view relationship differed between intubations performed in 14 patients who were intubated twice, once with a Macintosh and once with an Airtraq videolaryngoscope. Slopes were compared using least-squares linear regression and robust regression. RESULTS: The slope of the intubation force (N) versus glottic view (%) relationship with the Macintosh (−0.679 [standard error {SE}, 0.147]) was significantly more negative than that of the Airtraq (−0.076 [SE, 0.246]). The least-squares regression difference in slopes was −0.603 (SE, 0.287); P = .046. The robust regression difference in slopes was −0.747 (SE, 0.187); P = .0005. Thus, when compared with the Macintosh, intubation force magnitude with Airtraq laryngoscopy was less dependent on glottic visualization. CONCLUSIONS: Previously, we reported that intubation force with the Airtraq was less in magnitude compared with the Macintosh. Our current study adds that intubation force also is less dependent on glottic view with Airtraq compared with the Macintosh. (Anesth Analg 2022;135:815-9) KEY POINTS• Question: Does the relationship between glottic view and intubation force differ between direct (Macintosh) laryngoscopy and indirect (Airtraq) laryngoscopy? • Findings: Compared with the Macintosh, intubation force magnitude with Airtraq laryngoscopy was less dependent on glottic visualization. • Meaning: Force differences between direct and indirect laryngoscopes may depend, at least in part, on the mediating effect of glottic view. GLOSSARYASA = American Society of Anesthesiologists; CONSORT = Consolidated Standards of Reporting Trials; POGO = percentage of glottic opening; SD = standard deviation; SE = standard error

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Sex-Specific Intubation Biomechanics: Intubation Forces Are Greater in Male Than in Female Patients, Independent of Body Weight

Cited by 4 publications

References 29 publications

The use of STOPBANG questionnaire and other difficult airway determinants in difficult airway prediction and correlation.

The use of STOPBANG questionnaire and other difficult airway determinants in difficult airway prediction and correlation.

A Systematic Review and Meta-Analysis of Randomized Controlled Trials on Supine vs. Nonsupine Endotracheal Intubation

Relationship Between Glottic View and Intubation Force During Macintosh and Airtraq Laryngoscopy and Intubation

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