IS RHTMD A NEW PREDICTOR FOR ASSESSMENT OF DIFFICULT INTUBATION IN NON-OBESE PATIENTS?
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 38
Abstract
BACKGROUND The recognition of difficult intubation during pre-operative check-up is very important for the anaesthesiologist. Various anatomical parameters assist in predicting difficult intubation. Till date, there are no predictors available to precisely assess the risk of difficult intubation, pre-operatively. Therefore, we aim to identify the adequacy of predictors for preoperative assessment of difficult intubation. MATERIALS AND METHODS After ethical approval of Institutional Ethics Committee, a total of 200 non-obese patients (Body mass index less than or equal to 30) were recruited in this prospective observational study after obtaining informed consent. Mouth Opening (MO), Modified Mallampati Grading (MMG), neck circumference (cm), Thyromental Distance (TM), Sternomental Distance (SM), Neck Movement (NM), Neck Circumference (NC) and Ratio of Height to Thyromental Distance (RHTMD) were measured pre-operatively. In each patient, validated Intubation Difficulty Score (IDS score) was assessed intraoperatively by the anaesthetist. All patients were divided into two groups on the basis of easy (IDS score < 5) and difficult intubation (IDS score ≥ 5). Multivariate logistic regression analysis including all variables was used to create a predictive model. RESULTS Laryngoscopy was difficult in 12.0% of the patients. The MO, MMG, NM, NC, TM, SM, NC/TM were significantly different in between easy and difficult intubation. The Area Under Curve (AUC) in ROC for the TM, SM, NC/TM, RHTMD and MPC were 0, 270, 0.138, 0.848, 0.807 and 0.699, respectively. Among all indices, NC/TM and RHTMD were found to have high sensitivity and specificity. NC/TM was showing maximum area under the curve on ROC curve (AUC) followed by RHTMD. CONCLUSION Among non-obese patients, NC/TMD ratio and RHTMD can be used for better predictor of difficult intubation, pre-operatively.
Authors and Affiliations
Mamta Harjai, Priyesh Bhaskar, Shobhit Saxena, Shivani Rastogi, Prithvi Kumar Singh
Keywords
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