Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-24T12:46:07.770Z Has data issue: false hasContentIssue false
  • English
  • Français

Lateral neck radiography for prediction of difficult orotracheal intubation

Published online by Cambridge University Press:  26 August 2005

H. Kamalipour ,
M. Bagheri ,
K. Kamali ,
A. Taleie  and
H. Yarmohammadi
H. Kamalipour
Affiliation:
Shiraz University of Medical Sciences, Faghihi Hospital, Department of Anesthesiology, Shiraz, Iran
M. Bagheri
Affiliation:
Shiraz University of Medical Sciences, Nemazee Hospital, Department of Radiology, Shiraz, Iran
K. Kamali
Affiliation:
Shiraz University of Medical Sciences, Nemazee Hospital, Department of Radiology, Shiraz, Iran
A. Taleie
Affiliation:
Shiraz University of Medical Sciences, Faghihi Hospital, Department of Anesthesiology, Shiraz, Iran
H. Yarmohammadi
Affiliation:
Shiraz University of Medical Sciences, Faghihi Hospital, Department of Surgery, Shiraz, Iran
Get access

Extract

Summary

Background and objectives: Failed endotracheal intubation is a principal cause of morbidity and mortality in anesthetized patients. The aim of this study was to investigate the efficiency of lateral neck radiography in predicting difficult intubation. Methods: In a prospective triple-blind study, 100 patients (aged 18–89 yr), scheduled for elective surgery were randomly selected. Lateral neck X-ray was obtained from each of the patients before operation. Several angles and parameters on the X-ray were proposed to illustrate a relationship with easy or difficult intubation. A radiologist recorded these angles before the operation. An anaesthesiologist also determined the Mallampati score preoperation. At the time of intubation, two other anesthesiologists performed a laryngoscopy and, according to established criteria, identified the patients as easy or difficult intubation. The results were then compared with each other. Results: Fifteen patients were identified as having difficult intubation (laryngoscopy Grades III and IV). Sensitivity and specificity of the Mallampati Class test were 26% and 100%, respectively. The sensitivity and specificity of the lateral neck X-ray for three measured angles were 100%. The positive and negative predictive values (NPVs) for those angles were 100% and for Mallampati classification were 100% and 80%, respectively. Conclusions: Compared to the Mallampati Class test, our method of analyzing the lateral X-ray, although not as easy and universally applicable as Mallampati Class test, proved to be a suitable method for predicting difficult intubation.

Keywords

INTUBATION, INTRATRACHEAL, prediction, classification, MallampatiRADIOGRAPHY, neck, lateralLARYNGOSCOPY, direct
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 9 , September 2005 , pp. 689 - 693
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Jimson CT, Eric BR, Ayyaz H. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study. Anes Analg 1995; 81: 254–258.Google Scholar
Cormack RS, Lehnane J. Difficult tracheal intubation in obstetrics. Anesthesia 1984; 39: 1105–1111.Google Scholar
Caplan RA, Posner KL, Ward RJ et al. Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology 1990; 72: 828–833.Google Scholar
Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth 1988; 61: 211–216.Google Scholar
Charter P, Perera S, Horton WA. Visibility of pharyngeal structures as a predictor of difficult intubation. Anaesthesia 1987; 42: 1115.Google Scholar
Oates JDL, Macleod AD, Oates PD et al. Comparison of two methods for predicting difficult intubation. Br J Anaesth 1991; 66: 305–309.Google Scholar
Frerk CM. Predicting difficult intubation. Anaesthesia 1991; 46: 1005–1008.Google Scholar
Savva D. Prediction of difficult intubation. Br J Anaesth 1994; 73: 149–153.Google Scholar
Samra SK, Schork MA, Guinto Jr FC. A study of radiologic imaging techniques and airway grading to predict a difficult endotracheal intubation. J Clin Anesth 1995; 7: 373–379.Google Scholar
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; 46: 748–759.Google Scholar
Mallampati SR, Gatt SP, Gugino LD et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–434.Google Scholar
Sutton D. The pharynx and larynx. In: Sutton D, ed. Textbook of Radiology and Imaging, 6th edn. New York, USA: Churchill Livingstone Inc, 1998: 1273–1276.
Bontrager K. Radiology anatomy and positioning of the chest. In: Bontrager KL, ed. Textbook of Radiographic Positioning and Related Anatomy, 3rd edn. New York, USA: Mosby Year Book, 1993: 52–53.
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29–36.Google Scholar
Rocke DA, Murray WB, Rout CC et al. Relative risk analysis of factors associated with difficult intubation in obstetric anaesthesia. Anesthesiology 1992; 77: 67–73.Google Scholar
Samsoon GTL, Young JRB. Difficult intubation: a retrospective study. Anesthesia 1987; 42: 487–490.Google Scholar
Curry T, Dowdey J, Murry R. Protection. In: Christensen's Physics of Diagnostic Radiology, 4th edn. Philadelphia, USA: Lea and Febiger, 1990: 375–377.
Hung OR, Morris I. Dynamic anatomy of upper airway: an essential paradigm. Can J Anaesth 2000; 47: 295–298.Google Scholar