domingo, 27 de julio de 2014

Predictores de vía aérea/Airway predictors

La sensibilidad del signo de impresión de la palma en la predicción de laringoscopia difícil en la diabetes. Comparación con otros índices de vía aérea

Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices.
Hashim K, Thomas M.
Indian J Anaesth. 2014 May;58(3):298-302. doi: 10.4103/0019-5049.135042.
BACKGROUND AND AIMS: Diabetic patients are prone for the limited joint mobility syndrome. The atlanto-occipital joint involvement limits adequate extension of head and neck during laryngoscopy making intubation difficult. The collagen glycosylation starts in the fourth and fifth inter-phalangeal joints. The degree of inter-phalangeal involvement can be assessed by scoring the ink impression made by the palm of the dominant hand (palm print [PP] sign) The aim of our study was to evaluate the PP sign as a screening tool for predicting difficult laryngoscopy in diabetic patients. METHODS:A total of 60 diabetic patients undergoinggeneral anaesthesia with endotracheal intubation were assessed pre-operatively for their airway indices using the modified Mallampati test, thyromental distance, degree of head extension, the PP test and the prayer sign and their corresponding Cormack-Lehane scores were noted. Statistical analysis was performed using Fischer exact test. RESULTS: Of the 60 patients, 15 had positive PP sign. Of the 13 difficult laryngoscopies encountered, 10 patients had a positive PP sign. PP sign was the most sensitive index in predicting difficult laryngoscopy. P =0.000 was obtained and considered as statistically significant. The sensitivity was 76.9%, specificity 89.4%, positive and negative predictive value 71.4% and 91.3% and accuracy 86.7%, respectively. The other signs were not significant in predicting difficult laryngoscopy.CONCLUSION:The PP test appears to be the most sensitive and specific in the prediction of difficult laryngoscopy in diabetic patients.
KEYWORDS:Diabetes; difficult intubation; limited joint mobility;year=2014;volume=58;issue=3;spage=298;epage=302;aulast=Hashim;type=2

Características anatómicas del cuello como marcadores predictivos de dificultad para laringoscopia directa en los hombres y las mujeres: un estudio prospectivo.

Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study.
Chara L, Eleftherios V, Maria M, Anastasia T, Chryssoula S.
Indian J Anaesth. 2014 Mar;58(2):176-82. doi: 10.4103/0019-5049.130822.
BACKGROUND AND AIMS: Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study.
METHODS: We studied 341 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), sternomental distance (STMD), ratio of height to thyromental distance (RHTMD) and neck circumference (NC) were measured pre-operatively. The laryngoscopic view was classified according to the Cormack-Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack-Lehane Grade 3 or 4. The optimal cut-off points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. Comparisons between genders were also performed. RESULTS: Laryngoscopy was difficult in 12.6% of the patients. The cut-off values were: TMD ≤7 cm, STMD ≤15 cm, RHTMD >18.4 and NC >37.5 cm. The RHTMD had the highest sensitivity (88.4%) and NPV (95.2%), while TMD had the highest specificity (83.9%). The area under curve (AUC) for the TMD, STMD, RHTMD and NC was 0.63, 0.64, 0.62 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68, P < 0.001). Gender-specific cut-off points improved the predictive accuracy of NC in women (AUC: 0.65). CONCLUSIONS: The TMD, STMD, RHTMD and NC were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy. Among the studied tests, gender-specific cut-off points should be used for NC.
KEYWORDS:Height-to-thyromental distance ratio; laryngoscopy; neck circumference; sternomental distance; thyromental distance;year=2014;volume=58;issue=2;spage=176;epage=182;aulast=Chara;type=2

Anestesiología y Medicina del Dolor

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