使用多种筛查测试进行术前评估以预测困难气道

Preoperative Assessment to Predict Difficult Airway Using Multiple Screening Tests.

作者信息

Trambadia Dhwani N, Yadav Payal, A Sargunaraj

机构信息

Anesthesiology, Pandit Deendayal Upadhyay Medical Hospital, Rajkot, IND.

Anaesthesiology, Chirayu Private Hospital, Jaipur, IND.

出版信息

Cureus. 2023 Oct 11;15(10):e46868. doi: 10.7759/cureus.46868. eCollection 2023 Oct.

Abstract

Background Predicting a difficult airway is one of the necessities in anesthesiology practice. Recognition of an obviously difficult airway leads to a series of communication and preparations to assist, as well as the establishment and maintenance of the airway. In this study, we compared various predictors of difficult laryngoscopy/intubation to determine the best possible difficult airway predictors. The present study aimed to evaluate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the following airway assessment tests to predict difficult airway: (1) Modified Mallamapati test; (2) thyromental distance; (3) inter-incisor gap; (4) upper lip bite test; (5) LEMON airway assessment test; and (6) atlantooccipital movement. Methodology A total of 300 patients who presented for different operative procedures were selected. Screening tests were done in the preoperative examination room. The tests included the Modified Mallamapati test, thyromental distance, upper lip bite test, inter-incisor gap, LEMON airway assessment, and atlantooccipital movement. Laryngoscopy was done in the operation theater and the view was classified according to Cormack-Lehane's scale. Using this clinical data, the sensitivity, specificity, PPV, and NPV of each test in predicting difficult airways were calculated. Results The thyromental distance test had the highest sensitivity, NPV, and accuracy. The upper lip bite test had the highest specificity and PPV. LEMON airway assessment test had the lowest specificity, PPV, NPV, and accuracy. Thyromental distance had the highest accuracy followed by the Modified Mallampati test. Inter-incisor gap had low sensitivity and PPV, and the atlantooccipital extension test had low sensitivity. Conclusions The currently available screening tests for difficult intubation have only poor-to-moderate discriminative power when used alone. No single airway test can provide a high index of sensitivity and specificity for the prediction of difficult airways. The upper lip bite test had the highest specificity and the thyromental distance test had the highest NPV. Every anesthesiologist must be trained and equipped to deal with now much less common, unexpected failure to intubate.

摘要

背景

预测困难气道是麻醉实践中的必要工作之一。识别明显的困难气道会引发一系列沟通、准备工作以提供协助,以及气道的建立与维持。在本研究中,我们比较了各种困难喉镜检查/插管的预测指标,以确定最佳的困难气道预测指标。本研究旨在评估以下气道评估测试预测困难气道的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和准确性:(1)改良马兰帕蒂试验;(2)甲颏距离;(3)门齿间距;(4)上唇咬合试验;(5)LEMON气道评估试验;(6)寰枕活动度。方法:共选取300例因不同手术前来就诊的患者。在术前检查室进行筛查测试。测试包括改良马兰帕蒂试验、甲颏距离、上唇咬合试验、门齿间距、LEMON气道评估和寰枕活动度。在手术室进行喉镜检查,并根据科马克-莱汉内分级标准对视野进行分类。利用这些临床数据,计算每项测试预测困难气道的敏感性、特异性、PPV和NPV。结果:甲颏距离测试具有最高的敏感性、NPV和准确性。上唇咬合试验具有最高的特异性和PPV。LEMON气道评估试验的特异性、PPV、NPV和准确性最低。甲颏距离的准确性最高,其次是改良马兰帕蒂试验。门齿间距的敏感性和PPV较低,寰枕伸展试验的敏感性较低。结论:目前可用的困难插管筛查测试单独使用时,其鉴别能力仅为中等偏下。没有单一的气道测试能够为预测困难气道提供高敏感性和特异性指标。上唇咬合试验具有最高的特异性,甲颏距离测试具有最高的NPV。每位麻醉医生都必须接受培训并具备应对现在已不那么常见的意外插管失败的能力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c28d/10638107/06ef271e9d8d/cureus-0015-00000046868-i01.jpg

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