Pre-operative transnasal endoscopy as a predictor of difficult airway: A prospective cohort study

Marco Gemma, Luca Buratti, Davide Di Santo, Maria R. Calvi, Alfredo Ravizza, Stefano Bondi, Mario Bussi, Luigi Beretta

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUNDConsequences of failed endotracheal intubation can be catastrophic and predicting difficulty is therefore a critical issue. There is no consensus on the best way to predict difficulty.OBJECTIVETo evaluate the role of transnasal flexible endoscopic laryngoscopy (TFEL), a minimally invasive procedure, in the prediction of difficult intubation.DESIGNProspective cohort study.SETTINGSan Raffaele Hospital, Milan, a tertiary university hospital.PATIENTSOne hundred and sixty nine adults scheduled for elective ear, nose and throat surgery under general anaesthesia with pre-operative TFEL.INTERVENTIONIn addition to routine pre-operative evaluation by an anaesthesiologist, glottis exposure during TFEL was assessed with a scoring system similar to the modified Cormack-Lehane (MCL).MAIN OUTCOME MEASURESThe extent to which TFEL improves the prediction of difficult direct laryngoscopy, measured with the MCL score, and of difficult intubation, measured with the intubation difficulty scale score.RESULTSWhen added to bedside evaluation, TFEL performed during tongue protrusion significantly (P = 0.005) improved the prediction of MCL. The area under the receiver operating characteristics curve was 0.75 [95% confidence interval (CI) 0.67 to 0.83] vs. 0.65 (95% CI 0.58 to 0.74). For the intubation difficulty scale (P = 0.049), the area under the receiver operating characteristics curve was 0.70 (95% CI 0.61 to 0.80) vs. 0.66 (95% CI 0.58 to 0.74).CONCLUSIONTFEL is a useful tool in predicting difficult intubation, improving predictability of routine bedside evaluation.

Original languageEnglish
Pages (from-to)98-104
Number of pages7
JournalEuropean Journal of Anaesthesiology
Volume37
Issue number2
DOIs
Publication statusPublished - Feb 1 2020

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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