Wang C M Z, Pang K P, Tan S G, Pang K A, Pang E B, Cherilynn T Y N, Chan Y H, Rotenberg B W
Asia Sleep Centre, Department of Otolaryngology, Singapore.
Asia Sleep Centre, Department of Anaesthesiology, Singapore.
Med J Malaysia. 2019 Apr;74(2):133-137.
To evaluate predictors of difficult intubation in patients with obstructive sleep apnoea (OSA).
Prospective series of 405 OSA patients (350 males/55 females) who had upper airway surgery. Procedures included functional endoscopic sinus surgery, septoplasty, turbinate reduction, palate/tonsil surgery, and/or tongue base surgery. Intubation difficulty (ID) was assessed using Mallampati grade, Laryngoscopic grade (Cormack and Lehane), and clinical parameters including BMI, neck circumference, thyromental distance, jaw adequacy, neck movements and glidescope grading.
Mean age was 41.6 years old; mean BMI 26.6; mean neck circumference 44.5cm; mean Apnea Hypopnea Index (AHI) was 25.0; and mean LSAT 82%. The various laryngeal grades (based on Cormack and Lehane), grade 1 - 53 patients (12.9%), grade 2A - 127 patients (31.0%), grade 2B - 125 patients (30.5%), grade 3 - 93 patients (22.7%) and grade 4 - seven patients (1.7%); hence, 24.4% had difficulties in intubation. Parameters that adversely affected intubation were, age of the patient, opening of mouth, retrognathia, overbite, overjet, limited neck extension, thyromental distance, Mallampati grade, and macroglossia (p<0.001). Body mass index (BMI) (p=0.087), neck circumference (p=0.645), neck aches (p=0.728), jaw aches (p=0.417), tonsil size (p=0.048), and AHI (p=0.047) had poor correlation with intubation. BMI-adjusted for Asians and Caucasians, showed that Asians were more likely to have difficulties in intubation (adjusted OR = 4.6 (95%Confidence Interval: 1.05 to 20.06) (p=0.043), compared to the Caucasian group.
This study illustrates that difficult intubation can be predicted pre-surgery in order to avert any anaesthetic morbidity.
评估阻塞性睡眠呼吸暂停（OSA）患者插管困难的预测因素。
对405例接受上气道手术的OSA患者（350例男性/55例女性）进行前瞻性研究。手术包括功能性鼻内镜鼻窦手术、鼻中隔成形术、鼻甲切除术、腭/扁桃体手术和/或舌根手术。使用Mallampati分级、喉镜分级（Cormack和Lehane）以及包括体重指数（BMI）、颈围、颏甲距离、颌骨情况、颈部活动度和Glidescope分级在内的临床参数评估插管困难程度（ID）。
平均年龄41.6岁；平均BMI为26.6；平均颈围44.5cm；平均呼吸暂停低通气指数（AHI）为25.0；平均最低血氧饱和度（LSAT）为82%。不同喉镜分级（基于Cormack和Lehane）：1级 - 53例患者（12.9%），2A级 - 127例患者（31.0%），2B级 - 125例患者（30.5%），3级 - 93例患者（22.7%），4级 - 7例患者（1.7%）；因此，24.4%的患者存在插管困难。对插管产生不利影响的参数包括患者年龄、张口度、下颌后缩、覆牙合、覆盖、颈部伸展受限、颏甲距离、Mallampati分级和巨舌症（p<0.001）。体重指数（BMI）（p=0.087）、颈围（p=0.645）、颈部疼痛（p=0.728）、颌部疼痛（p=0.417）、扁桃体大小（p=0.048）和AHI（p=0.047）与插管的相关性较差。对亚洲人和白种人进行BMI校正后显示，与白种人群相比，亚洲人更有可能存在插管困难（校正比值比 = 4.6（95%置信区间：1.05至20.06）（p=0.043）。
本研究表明，为避免任何麻醉相关并发症，可在术前预测插管困难情况。
