| Reproducibilidad del inter-observador de 15 pruebas que se utilizan para predecir la intubación difícil. |
Inter-observer reproducibility of 15 tests used for predicting difficult intubation. Adamus M, Jor O, Vavreckova T, Hrabalek L, Zapletalova J, Gabrhelik T, Tomaskova H, Janout V. Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic. milan.adamus@seznam.cz. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011 Sep;155(3):275-81.Abstract Aim. To determine the inter-observer reproducibility of 15 tests used for predicting difficult tracheal intubation (DI). Material and methods. Following local ethics committee approval and informed consent, 101 volunteers were examined by two assessors using 15 tests for predicting DI. The two assessors who were blinded to the results of the other, examined each volunteer independently. Cohen's kappa (κ) or first-order agreement coefficient (AC1) were used to measure agreement between assessor ratings on a qualitative scale. Agreement between two quantitative outcomes was described using the intraclass correlation coefficient (ICC) and Pearson's (PCC) or Spearman's (SCC) correlation coefficients. The following interpretation of the coefficients was used: poor (< 0.20), fair (0.21-0.40), satisfactory (0.41-0.60), good (0.61-0.80), and excellent (0.81-1.00). Results. Respective coefficients of inter-rater agreement and correlation coefficients were determined for the following parameters: pathologies associated with DI (κ=0.662, AC1=0.990), clinical impression (κ=-0.013, AC1=0.969), modified Mallampati test (κ=0.503, AC1=0.861), upper lip bite test (κ=0.370, AC1=0.897), temporo-mandibular joint movement (κ=0.088, AC1=0.797), max. anteroflexion of C-spine (ICC=0.136, SCC=0.391), max. retroflexion of C-spine (ICC=0.020, SCC=0.284), mandibular length (ICC=0.301, SCC=0.553), neck circumference (ICC=0.832, SCC=0.928), hyo-mental distance (ICC=0.378, SCC=0.472), thyro-mental distance (ICC=-0.002, PCC=0.265), sternomental distance (ICC=0.674, PCC=0.815), and finally, inter-incisor gap (ICC=0.695, PCC=0.785). Two tests (positive history of DI and retrogenia), were excluded from calculation because no positive cases were found. Conclusion. Best inter-rater agreement was found for the assessment of neck circumference while the highest discrepancies between raters were in goniometrically-measured mobility of the C-spine. Many of the pre-operative airway tests had only fair inter-observer reproducibility. This may be one reason why models for predicting difficult intubation are not universally reliable. http://mefanet.upol.cz/BP/2011/3/275.pdf |
| Ultrasonido de la vía aérea |
Ultrasound of the airway. Kundra P, Mishra SK, Ramesh A. Department of Anaesthesiology & Critical Care, Jawaharlal Institute of Medical Education and Research, Pondicherry, India. Indian J Anaesth. 2011 Sep;55(5):456-62.Abstract Currently, the role of ultrasound (US) in anaesthesia-related airway assessment and procedural interventions is encouraging, though it is still ill defined. US can visualise anatomical structures in the supraglottic, glottic and subglottic regions. The floor of the mouth can be visualised by both transcutaneous view of the neck and also by transoral or sublinguial views. However, imaging the epiglottis can be challenging as it is suspended in air. US may detect signs suggestive of difficult intubation, but the data are limited. Other possible applications in airway management include confirmation of correct endotracheal tube placement, prediction of post-extubation stridor, evaluation of soft tissue masses in the neck prior to intubation, assessment of subglottic diameter for determination of paediatric endotracheal tube size and percutaneous dilatational tracheostomy. With development of better probes, high-resolution imaging, real-time picture and clinical experience, US has become the potential first-line noninvasive airway assessment tool in anaesthesia and intensive care practice http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237144/?tool=pubmed |
| Comparación de la relación de la talla con la distancia tiromentoniana con el Mallampati modificado y la mordida del labio superior para predecir dificultad durante la laringoscopía |
A comparison of the ratio of patient's height to thyromental distance with the modified Mallampati and the upper lip bite test in predicting difficult laryngoscopy.
Safavi M, Honarmand A, Zare N.
Departments of Anesthesiology and Critical Care, Alzahra and Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Saudi J Anaesth. 2011 Jul;5(3):258-63.
Abstract
BACKGROUND: THE AIM OF THE PRESENT STUDY WAS TO COMPARE THE ABILITY TO PREDICT DIFFICULT VISUALIZATION OF THE LARYNX FROM THE FOLLOWING PREOPERATIVE AIRWAY PREDICTIVE INDICES, IN ISOLATION AND COMBINATION: modified Mallampati test (MMT), the ratio of height to thyromental distance (RHTMD) and the Upper-Lip-Bite test (ULBT). METHODS: We collected data on 603 consecutive patients scheduled for elective surgery under general anesthesia requiring endotracheal intubation and then evaluated all three factors before surgery. An experienced anesthesiologist, not informed of the recorded preoperative airway evaluation, performed the laryngoscopy and grading (as per Cormack and Lehane's classification). Sensitivity, specificity, and positive and negative predictive value, Receiver operating characteristic (ROC) Curve and the area under ROC curve (AUC) for each airway predictor in isolation and in combination were determined. RESULTS: Difficult laryngoscopy (Grade 3 or 4) occurred in 41 (6.8%) patients. The main endpoint of the present study, the AUC of the ROC, was significantly lower for the MMT (AUC, 0.511; 95% CI, 0.470-0.552) than the ULBT (AUC, 0.709; 95% CI, 0.671-0.745, P=0.002) and the RHTMD score (AUC, 0.711; 95% CI, 0.673-0.747, P=0.001). There was no significant difference between the AUC of the ROC for the ULBT and the RHTMD score. By using discrimination analysis, the optimal cutoff point for the RHTMD for predicting difficult laryngoscopy was 21.06 (sensitivity, 75.6%; specificity, 58.5%). CONCLUSION: The RHTMD is comparable with ULBT for prediction of difficult laryngoscopy in general population
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