Kamranmanesh Mohammad R, Jafari Ali R, Gharaei Babak, Aghamohammadi Homayoun, Poor Zamany N K Mahtab, Kashi Amir H
Department of Anesthesiology, Critical Care and Pain Medicine, Anesthesiology Research Center, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Anesthesiology, Critical Care and Pain Medicine, Anesthesiology Research Center, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Acta Anaesthesiol Taiwan. 2013 Dec;51(4):141-4. doi: 10.1016/j.aat.2013.12.001. Epub 2014 Jan 21.
We aimed to compare the efficacy of a new bedside screening test named acromioaxillosuprasternal notch index (AASI) with modified Mallampati (MMP).
A total of 603 adult patients, who were candidates for tracheal intubation in elective surgery, were enrolled in this prospective study. Preoperative airway assessment was carried out with AASI and MMP. The new AASI score is calculated based on the following measurements: (1) using a ruler, a vertical line is drawn from the top of the acromion process to the superior border of the axilla at the pectoralis major muscle (line A); (2) a second line is drawn perpendicular to line A from the suprasternal notch (line B); and (3) the portion of line A that lies above the point where line B intersects it is line C. AASI is calculated by dividing the length of line C by that of line A (AASI = C/A). After induction of anesthesia, the laryngeal view was recorded according to the Cormack-Lehane grading system. Receiver operating characteristic curve analysis was employed to compare between AASI and MMP.
Difficult visualization of larynx (DVL, Cormack-Lehane III and IV) was observed in 38 (6.3%) patients. The best cutoff point for DVL was defined at AASI > 0.49. AASI had a lower false negative rate and higher predictive values (sensitivity, positive predictive value, and accuracy) in comparison with MMP.
AASI was associated with higher predictive values than MMP and could be used for estimation of DVL.
我们旨在比较一种名为肩峰-腋窝-胸骨上切迹指数（AASI）的新型床旁筛查试验与改良马兰帕蒂（MMP）试验的效果。
本前瞻性研究共纳入603例择期手术中拟行气管插管的成年患者。采用AASI和MMP进行术前气道评估。新的AASI评分基于以下测量计算：（1）用尺子从肩峰顶端向胸大肌处腋窝上缘画一条垂直线（A线）；（2）从胸骨上切迹向A线画一条垂直线（B线）；（3）B线与A线交点上方的A线部分为C线。AASI通过C线长度除以A线长度计算得出（AASI = C/A）。麻醉诱导后，根据Cormack-Lehane分级系统记录喉镜视野。采用受试者操作特征曲线分析比较AASI和MMP。
38例（6.3%）患者出现喉镜视野困难（DVL，Cormack-Lehane III级和IV级）。DVL的最佳截断点定义为AASI > 0.49。与MMP相比，AASI的假阴性率更低，预测值更高（敏感性、阳性预测值和准确性）。
AASI的预测值高于MMP，可用于评估DVL。
