Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Division of Anesthesia and Intensive Care, "Santa Maria delle Grazie" Hospital, Pozzuoli, Italy.
Anaesthesiol Intensive Ther. 2020;52(3):206-214. doi: 10.5114/ait.2020.97775.
Preoperative airway assessment plays a key role in the context of difficult airway management. Several scores have been proposed to predict difficult intubation including the el-Ganzouri index (EL.GA). Anatomical parameters such as the opening of the mouth or the circumference of the neck (which currently is not usually evaluated) are used to predict difficult intubation. The nutritional status of super-morbid obesity (body mass index [BMI] > 50 kg m-2) is a recognised risk factor for difficult intubation.
This is a single-centre, retrospective, observational study whose aim is to validate an additional parameter (anatomical plus nutritional) to the El.GA index, hence the choice of the acronym for the definition of the study: EL.GA+, in predictivity of airway management; multiple logistic regression analysis was performed to determine the predictive role of BMI, neck circumference and opening of the mouth of intubation difficulty measured with the gold standard.
In total, 240 patients who had an elective surgical procedure under general anaesthesia, requiring endotracheal intubation, were examined. The predictive value of the EL.GA score was confirmed by the values of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) according to the data reported in the literature. Furthermore, based on the values of the PPV and NPV (0.69 and 0.60 respectively), neck circumference of 42.5 cm can be taken as a cut-off value for which EL.GA+ becomes predictive of difficult intubation in patients with mild obesity (BMI of 30 to 35).
The EL.GA+ score greatly increases the prediction of difficult laryngoscopy in mildly obese patients.
术前气道评估在困难气道管理中起着关键作用。已经提出了几种评分来预测困难插管，包括 El-Ganzouri 指数 (EL.GA)。开口或颈部周长等解剖参数（目前通常不进行评估）用于预测困难插管。超病态肥胖（体重指数 [BMI] > 50 kg m-2）的营养状况是预测困难插管的公认危险因素。
这是一项单中心、回顾性、观察性研究，旨在验证 El.GA 指数的另一个参数（解剖学加营养）对气道管理预测的预测能力，因此选择了缩写词来定义研究：EL.GA+，用于衡量 BMI、颈部周长和张口度对插管困难的预测作用。采用多因素逻辑回归分析来确定 BMI、颈部周长和张口度与金标准测量的插管困难之间的预测作用。
共检查了 240 例接受全身麻醉下择期手术、需要气管插管的患者。EL.GA 评分的预测价值通过文献报道的敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV) 值得到了证实。此外，根据 PPV 和 NPV 的值（分别为 0.69 和 0.60），颈围 42.5 cm 可作为截断值，EL.GA+可用于预测轻度肥胖（BMI 为 30 至 35）患者的插管困难。
EL.GA+评分大大提高了对轻度肥胖患者喉镜检查困难的预测能力。
