Shirgoska B, Netkovski J
University Ear, Nose and Throat Clinic, Medical Faculty, Ss. Cyril and Methodius University, Skopje, R. Macedonia.
Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2013;34(1):155-9.
The aim of the study was to determine the predicting tests for difficult airway and difficult intubation in apparently normal patients.
We were using the literature about the specific tests for predicting difficult airway and single parameters that could be a significant test for prediction of difficult or impossible intubation. Clinical risk factors for difficult intubation in pediatric patients are related to the anatomic differences between pediatric patients and adults. Quantitative evaluation of difficult intubations could be realized using Cormack-Lehane (CL) scale and Mallampati score (without speaking--Mallampati test--and modified Mallampati test during speech). The Cormack-Lehane (CL) scale is a grading system commonly used to describe the view of the larynx during direct laryngoscopy. Grades 3 and 4, in which the glottis is not visualized, are considered difficult intubations. The Mallampati score, estimates the size of the tongue relative to the oral cavity and the ability to open the mouth. This system graded the patient (grades 1 to 4) based on the structures visible in the oropharynx with maximal mouth opening. Grade 3 or 4 suggests a significant chance that the patient will be difficult to intubate.
Our results showed that 24 patients (20 adult patients and 4 pediatric patients), 3.2% from total of 750 involved in the study had difficult intubation (Mallampati grades 3 and 4). 35% of the patients had impaired glottis exposure (grades 3 and 4 of the Cormack-Lehane scale).
We used only two criteria for describing both the visibility of the oropharyngeal structures and the quality of the laryngeal view. The effective and reliable prediction requires a combination of several parameters (BMI, head and neck movement, dentition status, upper lip bite test, interincisor gap and thyromental distance).
本研究的目的是确定表面正常患者气道困难和插管困难的预测性检查。
我们利用了关于预测气道困难的特定检查以及可能是预测困难或无法插管的重要检查的单一参数的文献。儿科患者插管困难的临床风险因素与儿科患者和成人之间的解剖差异有关。使用Cormack-Lehane（CL）分级和Mallampati评分（不说话时的Mallampati试验以及说话时的改良Mallampati试验）可以实现对困难插管的定量评估。Cormack-Lehane（CL）分级是一种常用于描述直接喉镜检查时喉部视野的分级系统。3级和4级，即看不到声门，被认为是困难插管。Mallampati评分评估舌头相对于口腔的大小以及张口能力。该系统根据最大张口时口咽可见结构对患者进行分级（1至4级）。3级或4级表明患者插管困难的可能性很大。
我们的结果显示，在参与研究的750名患者中，有24名患者（20名成年患者和4名儿科患者）插管困难（Mallampati分级为3级和4级），占总数的3.2%。35%的患者声门暴露受损（Cormack-Lehane分级为3级和4级）。
我们仅使用了两个标准来描述口咽结构的可视性和喉部视野质量。有效且可靠的预测需要多个参数（BMI、头颈部活动、牙列状况、上唇咬合试验、门齿间距和甲状软骨-颏下距离）的综合。
