Harjai Mamta, Alam Sharif, Rastogi Shivani, Kumar Sumit
Anesthesia and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND.
Anaesthesia, Hinchingbrooke Hospital, Huntingdon, GBR.
Cureus. 2023 Jul 15;15(7):e41933. doi: 10.7759/cureus.41933. eCollection 2023 Jul.
The anticipation of a challenging airway can be demanding in emergency care settings. Due to the patient's clinical condition, executing the pre-intubation clinical screening tests during the management of the airway in an emergency situation can be sometimes troublesome. Ultrasonographic airway assessment may become a helpful tool, but no specific sonographic measurements can precisely visualize the prospect of meeting a difficult airway. Therefore, the present study aimed to verdict some correlation between preoperative sonographic airway assessment parameters and the Cormack-Lehane (CL) grading at laryngoscopic view in patients undergoing general anesthesia with endotracheal intubation.
This observational study was conducted on 150 elective surgery subjects undergoing general anesthesia. The clinician in the pre-anesthetic clinic performed clinical airway and ultrasonographic airway assessments to predict difficult intubation and correlated with the CL grade viewed at laryngoscopy in the operative room during intubation. The parameters assessed were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
In this study, the incidence of difficult intubation was 13.3%. The Mallampatti Grading (MPG) showed the maximum receiver operating characteristic (ROC) and area under the curve (AUC) among the clinical predictors, with 86.7% sensitivity. At the same time, the skin-to-hyoid distance has the maximum ROC among the sonographic parameters, and the skin-to-thyroid isthmus has the utmost sensitivity to predict difficult laryngoscopy.
Among the clinical predictors, MPG and the sonographic parameters, like the skin-to-hyoid distance and skin-to-thyroid isthmus, are favorable predictors of difficult laryngoscopy.
在急诊护理环境中，预判困难气道可能具有挑战性。由于患者的临床状况，在紧急情况下气道管理过程中进行插管前临床筛查测试有时会很麻烦。超声气道评估可能成为一种有用的工具，但没有特定的超声测量能够精确显示遇到困难气道的可能性。因此，本研究旨在判定术前超声气道评估参数与接受气管插管全身麻醉患者喉镜检查时的Cormack-Lehane（CL）分级之间的相关性。
本观察性研究对150例接受全身麻醉的择期手术患者进行。麻醉前门诊的临床医生进行临床气道和超声气道评估以预测困难插管，并与插管期间手术室喉镜检查时的CL分级相关联。评估的参数包括敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在本研究中，困难插管的发生率为13.3%。在临床预测指标中，Mallampatti分级（MPG）显示出最大的受试者工作特征（ROC）曲线下面积（AUC），敏感性为86.7%。同时，在超声参数中，皮肤至舌骨距离具有最大的ROC，而皮肤至甲状腺峡部对预测困难喉镜检查具有最高的敏感性。
在临床预测指标以及超声参数（如皮肤至舌骨距离和皮肤至甲状腺峡部）中，MPG是困难喉镜检查的良好预测指标。
