domingo, 3 de agosto de 2014

Predictores de vía aérea/Airway predictors

Medición de la distancia tiromentoniana. Los dedos no sirven

Thyromental distance measurement--fingers don't rule.
Baker PA, Depuydt A, Thompson JM.
Anaesthesia. 2009 Aug;64(8):878-82. doi: 10.1111/j.1365-2044.2009.05985.x.
Thyromental distance (TMD) measurement is commonly used to predict difficult intubation. We surveyed anaesthetists to determine how this test was being performed. Comparative accuracy of ruler measurement and other forms of measurement were also assessed in a meta-analysis of published literature. Of respondents, 72% used fingers for TMD measurement and also considered three finger widths the minimum acceptable TMD. In terms of distance, the minimum acceptable TMD was felt to be 6.5 cm by 55% of respondents. However, the actual width of three fingers was (range) 4.6-7.0 cm (mean 5.9 cm), with significant differences between genders and between proximal and distal interphalangeal joints. The meta-analysis showed ruler measurement increased test sensitivity (48% (95% CI 43-53) vs 16% (95% CI 14-19) without a ruler), when predicting difficult intubation.

Precisión de las mediciones de dedo para estimar la distancia tiromentoniana. Un breve informe.
Accuracy of fingerbreadth measurements for thyromental distance estimates: a brief report.
Kiser M, Wakim JA, Hill L.
AANA J. 2011 Feb;79(1):15-8.
There have been many contradicting studies as to how well preoperative airway assessments predict difficult intubation. One of these measures,thyromental distance (TMD), has often been called into question. However, there have been no published studies evaluating whether anesthesia practitioners are measuring TMD accurately, especially if they use fingerbreadths as opposed to a centimeter ruler. A convenience sample of 60 anesthesia providers were asked to participate in a brief study. The subjects were asked a series of questions, including the type of anesthesia provider they were, how often they used TMD, and their estimates in centimeters of the following fingerbreadth combinations: index finger, index and second finger, index plus second and third fingers, and index plus second, third, and fourth fingers. After their estimates were recorded, exactmeasurements of the fingerbreadth combinations were made at the distal interphalangeal (DIP) joints. The differences between the means of the estimated and the actual measurements were analyzed using an independent t test. There was a statistically significant difference between estimated and actual fingerbreadth measurement for the index finger (P < .006) but not for the combinations of fingers.

Anestesiología y Medicina del Dolor

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