Rajkhowa Tejwant, Saikia Priyam, Das Deepjyoti
Department of Anaesthesiology and Critical Care, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Indian J Anaesth. 2018 Dec;62(12):945-950. doi: 10.4103/ija.IJA_480_18.
Bedside screening test for predicting difficult intubation is an accepted practice, even though its clinical value remains limited. This study aimed to study the predicting value of acromioaxillosuprasternal notch index (AASI) for difficult visualisation of the larynx (DVL).
After Hospital Ethical Committee approval, 440 consecutive consenting adult non-obstetric patients were included in this study. AASI, modified Mallampati class (MMT), sternomental distance (SMD), thyromental distance (TMD) and inter incisor distance (IID) were evaluated preoperatively by trained personnel. Visualisation of larynx was graded according to Cormack-Lehane grading, with grade III and IV being considered as DVL. The cut-off values for prediction of DVL were defined a . Direct laryngoscopy was carried out by qualified anaesthesiologists blinded to the results of the airway predictors under evaluation. Primary outcome variable was AASI as a predictor of DVL. Comparing DVL with MMT, SMD, TMD and IID were secondary objectives.
DVL was observed in 3.6% [95% confidence interval (1.9-5.4%)] patients. We observed that sensitivity, specificity and Area Under Curve i.e., AUC (95% confidence interval) of ROC of AASI was 81.25 (53.69-95.03), 96.7 (94.39-98.11) and 0.890 (0.777-1.000) respectively. AUC of AASI was found to better than MMT, SMD, TMD and IID.
AASI (≥0.5) is a good predictor of difficult visualisation of the larynx at direct laryngoscopy.
尽管床边预测困难插管的筛查试验临床价值有限，但仍是一种公认的做法。本研究旨在探讨肩峰-腋窝-胸骨上切迹指数（AASI）对喉镜直视困难（DVL）的预测价值。
经医院伦理委员会批准，本研究纳入了440例连续同意参与的成年非产科患者。术前由经过培训的人员评估AASI、改良马兰帕蒂分级（MMT）、胸骨-颏距离（SMD）、甲状软骨-颏距离（TMD）和门齿间距（IID）。根据Cormack-Lehane分级对喉镜直视情况进行分级，III级和IV级视为DVL。定义预测DVL的截断值。由对正在评估的气道预测指标结果不知情的合格麻醉医生进行直接喉镜检查。主要结局变量是AASI作为DVL的预测指标。将DVL与MMT、SMD、TMD和IID进行比较是次要目标。
3.6%[95%置信区间（1.9 - 5.4%）]的患者出现DVL。我们观察到AASI的ROC曲线下面积（即AUC，95%置信区间）的敏感性、特异性分别为81.25（53.69 - 95.03）、96.7（94.39 - 98.11）和0.890（0.777 - 1.000）。发现AASI的AUC优于MMT、SMD、TMD和IID。
AASI（≥0.5）是直接喉镜检查时喉镜直视困难的良好预测指标。
