de Carvalho Clístenes Crístian, da Silva Danielle Melo, Leite Marina Sampaio, de Andrade Lívia Barboza
Instituto de Medicina Integra Professor Fernando Figueira, Recife, PE, Brazil; Universidade Federal de Campina Grande, Departamento de Cirurgia, Campina Grande, PA, Brazil.
Hospital das Clínicas de Pernambuco, Recife, PE, Brazil.
Braz J Anesthesiol. 2023 Sep-Oct;73(5):570-577. doi: 10.1016/j.bjane.2022.04.004. Epub 2022 May 13.
Predicting difficult direct laryngoscopies remains challenging and improvements are needed in preoperative airway assessment. We conceived two new tests (the upper airway angle and the glottic height) and assessed their association with difficult direct laryngoscopies as well as their predictive performance.
A prospective cohort was conducted with 211 patients undergoing general anesthesia for surgical procedures. We assessed the association between difficult laryngoscopies and modified Mallampati Test (MMT), Upper Lip Bite Test (ULBT), Mandibular Length (ML), Neck Circumference (NC), Mouth Opening (MO), Sternomental Distance (SMD), Thyromental Distance (TMD), Upper Airway Angle (UAA), and Glottic Height (GH). We also estimated their predictive values.
Difficult laryngoscopy was presented by 12 patients (5.7%). Six tests were significantly associated with difficult laryngoscopies and their area under the ROC curve, and 95% CIs were as follows: UAA = 88.82 (81.86-95.78); GH = 86.43 (72.67-100); ML = 83.75 (72.77-94.74); NC = 79.17 (64.98-93.36); MO = 65.58 (45.13-86.02); and MMT = 77.89 (68.37-87.41).
We have found two new features (the UAA and the GH) to be significantly associated with the occurrence of difficult direct laryngoscopies. They also presented the best predictive performance amongst the nine evaluated tests in our cohort of patients. We cannot ensure, however, these tests to be superior to other regularly used bedside tests based on our estimated 95% CIs.
预测困难直接喉镜检查仍然具有挑战性，术前气道评估需要改进。我们构思了两项新测试（上气道角度和声门高度），并评估了它们与困难直接喉镜检查的关联及其预测性能。
对211例接受外科手术全身麻醉的患者进行了一项前瞻性队列研究。我们评估了困难喉镜检查与改良Mallampati试验（MMT）、上唇咬试验（ULBT）、下颌长度（ML）、颈围（NC）、张口度（MO）、胸骨颏距离（SMD）、甲状软骨颏距离（TMD）、上气道角度（UAA）和声门高度（GH）之间的关联。我们还估计了它们的预测价值。
12例患者（5.7%）出现困难喉镜检查。六项测试与困难喉镜检查及其ROC曲线下面积显著相关，95%置信区间如下：UAA = 88.82（81.86 - 95.78）；GH = 86.43（72.67 - 100）；ML = 83.75（72.77 - 94.74）；NC = 79.17（64.98 - 93.36）；MO = 65.58（45.13 - 86.02）；MMT = 77.89（68.37 - 87.41）。
我们发现两项新特征（UAA和GH）与困难直接喉镜检查的发生显著相关。在我们的患者队列中，它们在九项评估测试中也表现出最佳的预测性能。然而，根据我们估计的95%置信区间，我们不能确保这些测试优于其他常用的床旁测试。
