Del Buono Romualdo, Sabatino Lorenzo, Greco Federico
Unit of Anesthesia, Intensive Care and Pain Management, University Campus Bio-Medico, Rome, Italy.
Unit of Otolaryngology, University Campus Bio-Medico, Rome, Italy.
Saudi J Anaesth. 2018 Jan-Mar;12(1):67-71. doi: 10.4103/sja.SJA_398_17.
Direct laryngoscopy is the gold standard of the airway management in patients without predicted difficulties. If unpredicted difficulties are encountered instead, different algorithms to follow have been developed. To date, no single predictor is sufficiently valid. In clinical practice, it is used a combination of them to enhance the estimate, and despite the variety of parameters used, not all the difficult intubations are predicted. The aim of this work is to retrospectively analyze neck computed tomography scans of 37 patients who have had tracheal intubation and search for anatomic neck fat compartments that correlate with the intubation difficulty, and eventually find a suitable, clinical parameter that can potentially enhance the prediction of a difficult airway when used in combination of the preexisting scores.
the patients are divided by direct laryngoscopy view into two groups: Group A ( = 31): Normal airway, with a Cormack Lehane, Score I or II; Group B ( = 6): Difficult airway, with a Cormack Lehane Score III or IV. In the zone of interest, it was measured the neck volume parameter and other subparameters.
Despite a positive trend is shown for anterior fat volume (AFV) ( = 0.23) and fat volume (FV) ( = 0.28), statistically significant differences ( < 0.05) were not found between Group A and B in any of the measurements acquired.
According to the literature, our results confirmed that there is still no single element that can predict a difficult intubation. Although no statistical significance was found, the AFV and FV have shown to have a potential predictive role for difficult intubation. Further studies with bigger samples are advisable to confirm this encouraging result.
直接喉镜检查是无预计困难患者气道管理的金标准。若遇到未预计到的困难，则已制定了不同的应对方案。迄今为止，尚无单一预测指标具有足够的有效性。在临床实践中，通常联合使用多种指标来提高评估准确性，尽管使用的参数多种多样，但并非所有困难插管都能被预测到。本研究的目的是回顾性分析37例接受气管插管患者的颈部计算机断层扫描，寻找与插管困难相关的颈部脂肪解剖区域，并最终找到一个合适的临床参数，当其与现有评分联合使用时，有可能提高对困难气道的预测能力。
根据直接喉镜检查结果将患者分为两组：A组（n = 31）：气道正常，Cormack Lehane评分I或II级；B组（n = 6）：困难气道，Cormack Lehane评分III或IV级。在感兴趣区域测量颈部体积参数和其他子参数。
尽管前位脂肪体积（AFV）（p = 0.23）和脂肪体积（FV）（p = 0.28）呈现出阳性趋势，但在A组和B组之间，所获得的任何测量值均未发现统计学显著差异（p < 0.05）。
根据文献，我们的结果证实，仍然没有单一因素能够预测困难插管。尽管未发现统计学意义，但AFV和FV已显示出对困难插管具有潜在的预测作用。建议进行更大样本量的进一步研究以证实这一令人鼓舞的结果。
