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Does neck circumference help to predict difficult intubation in obstetric patients? A prospective observational study.

ABSTRACT: Background:Failed intubation in obstetrics remains the most common cause of death directly related to anesthesia. Neck circumference has been shown to be a predictor for difficult intubation in morbidly obese patients. The aim of this study was to determine an optimal cutoff point of neck circumference for prediction of difficult intubation in obstetric patients. Methods:Ninety-four parturients scheduled for cesarean section under general anesthesia were included in the study. Preoperative airway assessment and neck circumference were measured. Difficult intubation was the primary outcome according to the intubation difficulty scale (IDS), intubation reported difficult if the IDS score was ?5. Results:Univariate analysis showed that Mallampati score and neck circumference were positive predictors for difficult intubation (P = 0.005 and P = 0.011, respectively). Mouth opening, thyromental distance, sternomental distance, and the hyomental distance ratio were not useful predictors (P = 0.68, P = 0.87, P = 0.48, and P = 0.27, respectively). Logistic regression for the Mallampati score and neck circumference negative results as independent predictors of difficult intubation in obstetric (P = 0.53). Sensitivity analysis showed that neck circumference of 33.5 cm is the cutoff point to detect difficult intubation with 100% sensitivity (95% confidence interval [CI]: 69.2-100) and 50% specificity (95% CI: 38.9-61.1). The area under the curve for neck circumference was 0.746 (95% CI: 0.646-0.830) with a positive predictive value of 19.2 (95% CI: 9.6-32.5), a negative predicative value of 100 (95% CI: 91.6-100), and a P < 0.0001. Conclusions:In obstetric patients, a neck circumference ?33.5 cm is a sensitive predictor for difficult intubation.

SUBMITTER: Riad W

PROVIDER: S-EPMC5789511 | biostudies-literature | 2018 Jan-Mar

REPOSITORIES: biostudies-literature

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Does neck circumference help to predict difficult intubation in obstetric patients? A prospective observational study.

Riad Waleed W Ansari Tarek T Shetty Nanda N

Saudi journal of anaesthesia 20180101 1

<h4>Background</h4>Failed intubation in obstetrics remains the most common cause of death directly related to anesthesia. Neck circumference has been shown to be a predictor for difficult intubation in morbidly obese patients. The aim of this study was to determine an optimal cutoff point of neck circumference for prediction of difficult intubation in obstetric patients.<h4>Methods</h4>Ninety-four parturients scheduled for cesarean section under general anesthesia were included in the study. Pre ...[more]

PMID: 29416461

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Project description:PurposeTo investigate the characteristics of difficult intubation and identify novel efficient predictors in patients with acromegaly.MethodsPatients with either untreated acromegaly or non-functional pituitary adenomas were enrolled. Patients with acromegaly underwent hormone assays, upper airway computed tomography and magnetic resonance imaging examinations and preoperative overnight polysomnography. The modified Mallampati classification, mouth opening, neck circumference, and neck extension were assessed, and the Cormack-Lehane grades and the time of tracheal intubation were recorded.ResultsPatients with acromegaly had a higher incidence of difficult intubation (62.5%). The time of tracheal intubation was prolonged, the neck circumference was enlarged, and the neck extension was confined. In patients with acromegaly and difficult intubation, the insulin-like growth factor 1 levels and apnea/hypoxia index were significantly higher compared to patients without difficult intubation (1115.40?±?253.73 vs. 791.67?±?206.62 ng/ml, P?=?0.020; 22.17?±?23.25 vs. 2.47?±?2.84, P?=?0.026, respectively). The bilateral regression analysis revealed that high levels of insulin-like growth factor 1 were an independent risk factor for developing difficult intubation (p?=?0.042, Exp B?=?1.006). The modified Mallampati classification was positively correlated with apnea/hypoxia index and could be calculated using the following logarithmic equation: MMC?=?0.2982 * ln (AHI)?+?2.1836.ConclusionsIn patients with acromegaly, neck movement is confined, the time of tracheal intubation is prolonged, and the neck circumference is enlarged, and these patients suffer from an increased incidence of difficult intubation (62.5%) during anesthesia induction. The apnea/hypoxia index and insulin-like growth factor 1 levels are both increased in acromegalic patients with difficult intubation, and elevated insulin-like growth factor 1 levels are an independent risk factor of difficult intubation in acromegalic patients.

Project description:Unexpected difficult airway management can cause significant morbidity and mortality in patients admitted for elective procedures. Ultrasonography is a promising tool for perioperative airway assessment, nevertheless it is still unclear which sonographic parameters are useful predictors of difficult laryngoscopy and tracheal intubation. To determine the ultrasonographic predictors of a difficult airway that could be applied for routine practice, a systematic review and meta-analysis was conducted. Literature search was performed on PubMED, Web of Science and Embase using the selected keywords. Human primary studies, published in English with the use of ultrasonography to prediction of difficult laryngoscopy or tracheal intubation were included. A total of 19 articles (4,570 patients) were analyzed for the systematic review and 12 articles (1,141 patients) for the meta-analysis. Standardized mean differences between easy and difficult laryngoscopy groups were calculated and the parameter effect size quantified. A PRISMA methodology was used and the critical appraisal tool from Joanna Briggs Institute was applied. Twenty-six sonographic parameters were studied. The overall effect of the distance from skin to hyoid bone (p = 0.02); skin to epiglottis (p = 0.02); skin to the anterior commissure of vocal cords (p = 0.02), pre-epiglottis space to distance between epiglottis and midpoint between vocal cords (p = 0.01), hyomental distance in neutral (p < 0.0001), and extended (p = 0.0002) positions and ratio of hyomental distance in neutral to extended (p = 0.001) was significant. This study shows that hyomental distance in the neutral position is the most reliable parameter for pre-operative airway ultrasound assessment. The main limitations of the study are the small sample size, heterogeneity of studies, and absence of a standardized ultrasonographic evaluation method [Registered at International prospective register of systematic reviews (PROSPERO): number 167931].

Project description:BackgroundWe aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity.MethodsData from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests.ResultsIn the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79-1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65-1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower.ConclusionThe benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting.Clinical trial registrationNCT02210221.

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Does neck circumference help to predict difficult intubation in obstetric patients? A prospective observational study.

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Does neck circumference help to predict difficult intubation in obstetric patients? A prospective observational study.

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