Anatomic Features of the Neck and Preoperative Tests as Predictive Markers of Difficult Laryngoscopy

NCT02957084 | Completed

• 1 other identifier: 10634
• Study Type: observational
• Target: 1,142
• Locations: 0 countries
• Sites: N/A

Brief Summary

In this prospective, open cohort study the diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed. The anatomic features of the neck measured were head extension, mouth opening, upper lip bite, Mallampati class, thyromental distance, sternomental distance, ratio of height to thyromental, neck circumference, thyrosternal distance, hyomental distance at full head extension (FHE) and at neutral position (NP), ratio of neck circumference to thyromental distance and ratio of hyomental distance FHE to hyomental distance NP.

Conditions

Airway Management; Predictive Value of Tests

Keywords

difficult laryngoscopy; neck circumference; sternomental distance; thyromental distance; hyomental distance; thyrosternal distance

Outcome Measures

Primary Outcomes (1)

• Difficult laryngoscopy classification using Cormack-Lehane Grade

  Assessment of difficult laryngoscopy at the time of the airway management procedure. Classified as Grade I - visualization of entire laryngeal aperture, grade II - visualization of only posterior commissure of laryngeal aperture, grade III - visualization of only epiglottis, grade IV - visualization of just the soft palate.

  immediate

Secondary Outcomes (13)

• Thyromental distance measured in cm with a measuring tape

  immediate

• Sternomental distance measured in cm with a measuring tape

  immediate

• Ratio of height to thyromental distance

  immediate

• Thyrosternal distance calculated in cm

  immediate

• Neck circumference measured in cm with a measuring tape

  immediate

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult patients with BMI less than 35 kg/m2, wihthout any known neck or airway pathology, scheduled for surgical procedures under general anaesthesia with tracheal intubation were assessed for eligibility to be included in the study.

You may qualify if:

• Adult patients
• BMI less than 35 kg/m2
• No known neck or airway pathology
• Scheduled for surgical procedures under general anaesthesia with tracheal intubation

You may not qualify if:

• Age less than 18 years
• BMI higher than 35 kg/m2
• Obvious airway malformations
• Need for rapid sequence induction/intubation under cricoid pressure
• Awake intubation
• Cervical spine pathology requiring specific manipulation
• Obstetric cases

Sponsors & Collaborators

• National and Kapodistrian University of Athens: lead

Related Publications (22)

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  PMID: 18946426 BACKGROUND

• Cheney FW. The American Society of Anesthesiologists Closed Claims Project: what have we learned, how has it affected practice, and how will it affect practice in the future? Anesthesiology. 1999 Aug;91(2):552-6. doi: 10.1097/00000542-199908000-00030. No abstract available.

  PMID: 10443619 BACKGROUND

• Chipas A, Ellis W, Zaglaniczny K. Airway management. In: Zaglaniczny K, Nagelhout J. Nurse Anesthesia. 3rd edition. USA: Elsevier Saunders; 2004:408

  BACKGROUND

• Crosby ET, Cooper RM, Douglas MJ, Doyle DJ, Hung OR, Labrecque P, Muir H, Murphy MF, Preston RP, Rose DK, Roy L. The unanticipated difficult airway with recommendations for management. Can J Anaesth. 1998 Aug;45(8):757-76. doi: 10.1007/BF03012147.

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• Lundstrom LH. Detection of risk factors for difficult tracheal intubation. Dan Med J. 2012 Apr;59(4):B4431.

  PMID: 22459727 BACKGROUND

• Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005 Jul;103(1):33-9. doi: 10.1097/00000542-200507000-00009.

  PMID: 15983454 BACKGROUND

• Rucker JC, Cole D, Guerina LR, Zoran N, Chung F, Friedman Z. A prospective observational evaluation of an anatomically guided, logically formulated airway measure to predict difficult laryngoscopy. Eur J Anaesthesiol. 2012 May;29(5):213-7. doi: 10.1097/EJA.0b013e3283502168.

  PMID: 22450528 BACKGROUND

• Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005 Aug;103(2):429-37. doi: 10.1097/00000542-200508000-00027.

  PMID: 16052126 BACKGROUND

• Koay CK. Difficult tracheal intubation--analysis and management in 37 cases. Singapore Med J. 1998 Mar;39(3):112-4.

  PMID: 9632969 BACKGROUND

• Burkle CM, Walsh MT, Harrison BA, Curry TB, Rose SH. Airway management after failure to intubate by direct laryngoscopy: outcomes in a large teaching hospital. Can J Anaesth. 2005 Jun-Jul;52(6):634-40. doi: 10.1007/BF03015776.

  PMID: 15983152 BACKGROUND

• Cattano D, Panicucci E, Paolicchi A, Forfori F, Giunta F, Hagberg C. Risk factors assessment of the difficult airway: an italian survey of 1956 patients. Anesth Analg. 2004 Dec;99(6):1774-1779. doi: 10.1213/01.ANE.0000136772.38754.01.

  PMID: 15562070 BACKGROUND

• Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth. 1994 May;41(5 Pt 1):372-83. doi: 10.1007/BF03009858.

  PMID: 8055603 BACKGROUND

• Turkan S, Ates Y, Cuhruk H, Tekdemir I. Should we reevaluate the variables for predicting the difficult airway in anesthesiology? Anesth Analg. 2002 May;94(5):1340-4, table of contents. doi: 10.1097/00000539-200205000-00055.

  PMID: 11973217 BACKGROUND

• Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984 Nov;39(11):1105-11.

  PMID: 6507827 BACKGROUND

• Khan ZH, Kashfi A, Ebrahimkhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg. 2003 Feb;96(2):595-9, table of contents. doi: 10.1097/00000539-200302000-00053.

  PMID: 12538218 BACKGROUND

• Patil VU, Stehling LC, Zauder HL. Predicting the difficulty of intubation utilizing an intubation gauge. Anesthesiol Rev. 1983;10:32-3.

  BACKGROUND

• Savva D. Prediction of difficult tracheal intubation. Br J Anaesth. 1994 Aug;73(2):149-53. doi: 10.1093/bja/73.2.149.

  PMID: 7917726 BACKGROUND

• Naguib M, Malabarey T, AlSatli RA, Al Damegh S, Samarkandi AH. Predictive models for difficult laryngoscopy and intubation. A clinical, radiologic and three-dimensional computer imaging study. Can J Anaesth. 1999 Aug;46(8):748-59. doi: 10.1007/BF03013910.

  PMID: 10451134 BACKGROUND

• Gupta S, Sharma R, Jain D. Airway assessment: predictors of difficult airway. Indian J Anaesth. 2005:49(4):257-62

  BACKGROUND

• Schmitt HJ, Kirmse M, Radespiel-Troger M. Ratio of patient's height to thyromental distance improves prediction of difficult laryngoscopy. Anaesth Intensive Care. 2002 Dec;30(6):763-5. doi: 10.1177/0310057X0203000607.

  PMID: 12500514 BACKGROUND

• Huh J, Shin HY, Kim SH, Yoon TK, Kim DK. Diagnostic predictor of difficult laryngoscopy: the hyomental distance ratio. Anesth Analg. 2009 Feb;108(2):544-8. doi: 10.1213/ane.0b013e31818fc347.

  PMID: 19151285 BACKGROUND

• Greek Society for Airway management, Basic and Advanced Management of the Airway, 2nd edition, Athens, 2011

  BACKGROUND

Study Officials

• Chryssoula Staikou, MD, PhD, Assistant Professor

  National and Kapodistrian University of Athens, 1st Department of Anaesthesia, Aretaieio Hospital

  STUDY DIRECTOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: RN, Msc, Phd(c)

Study Record Dates

• First Submitted: October 29, 2016
• First Posted: November 7, 2016
• Study Start: March 1, 2013
• Primary Completion: December 1, 2014
• Study Completion: December 1, 2014
• Last Updated: November 7, 2016

Record last verified: 2016-11

Data Sharing

• IPD Sharing: Will not share