Suryawanshi Chhaya M, Bhatia Jayant
Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.
Cureus. 2024 Aug 12;16(8):e66706. doi: 10.7759/cureus.66706. eCollection 2024 Aug.
Bedside screening tests for predicting difficult intubation play a crucial role in clinical practice, although their utility remains limited. This prospective observational study aimed to assess the predictive value of the Acromio-Axillo-Suprasternal Notch Index (AASI) for difficult visualization of the larynx (DVL). Following approval from the Institutional Ethics Sub-Committee (Research Protocol No.: IESC/FP/68/2023), this prospective, observational, single-center study involved a sample size of 100 consecutive adult patients, both male and female, aged 20 to 65 years. The participants were classified as American Society of Anesthesiologists (ASA) grade I or II and were scheduled for elective surgeries necessitating endotracheal intubation. Before the operation, the following factors were assessed: AASI, modified Mallampati test (MMT), sternomental distance (SMD), thyromental distance (TMD), and inter-incisor distance (IID). Larynx visualization was evaluated using the Cormack-Lehane (CL) grading system, where grades III and IV indicate difficult laryngeal visualization. Qualified anesthesiologists performed direct laryngoscopy while remaining unaware of the outcomes of the airway predictors being assessed. The main aim of the investigation was to assess the efficacy of the AASI as a means of predicting DVL. The research study's secondary goals involved evaluating the accuracy of AASI in predicting challenging airways compared to other predictors such as MMT, SMD, TMD, and IID. DVL was observed in 21% of patients, out of which 10 and 11 were males and females, respectively. The sensitivity, specificity, and area under the curve (AUC) of the AASI were observed and reported with a 95% confidence interval (CI), being 98.73% (93.2-99.9%), 71.43% (47.8-88.7%), and 0.851 (0.732-0.970), respectively. AUC analysis revealed that AASI outperformed MMT, SMD, TMD, and IID as a predictor of DVL. AASI (≥0.5) serves as an excellent predictor for DVL during direct laryngoscopy. This finding suggests the clinical utility of AASI in identifying patients who may require special consideration during intubation procedures.
用于预测困难插管的床旁筛查试验在临床实践中发挥着关键作用，尽管其效用仍然有限。这项前瞻性观察性研究旨在评估肩峰-腋窝-胸骨上切迹指数（AASI）对喉镜困难可视化（DVL）的预测价值。在获得机构伦理小组委员会批准（研究方案编号：IESC/FP/68/2023）后，这项前瞻性、观察性、单中心研究纳入了100例年龄在20至65岁之间的连续成年患者样本，包括男性和女性。参与者被分类为美国麻醉医师协会（ASA）I级或II级，计划进行需要气管插管的择期手术。在手术前，评估了以下因素：AASI、改良Mallampati试验（MMT）、胸骨颏距离（SMD）、甲状颏距离（TMD）和门齿间距离（IID）。使用Cormack-Lehane（CL）分级系统评估喉镜可视化情况，其中III级和IV级表示喉镜可视化困难。合格的麻醉医师进行直接喉镜检查，同时对正在评估的气道预测指标的结果不知情。该调查的主要目的是评估AASI作为预测DVL的手段的有效性。该研究的次要目标包括评估AASI与其他预测指标（如MMT、SMD、TMD和IID）相比，在预测具有挑战性的气道方面的准确性。21%的患者观察到DVL，其中男性和女性分别为10例和11例。观察并报告了AASI的敏感性、特异性和曲线下面积（AUC），其95%置信区间（CI）分别为98.73%（93.2-99.9%）、71.43%（47.8-88.7%）和0.851（0.732-0.970）。AUC分析显示，作为DVL的预测指标，AASI优于MMT、SMD、TMD和IID。AASI（≥0.5）是直接喉镜检查期间DVL的优秀预测指标。这一发现表明AASI在识别插管过程中可能需要特殊考虑的患者方面具有临床实用性。
