Difficult laryngoscopy and intubation in the Indian population: An assessment of anatomical and clinical risk factors
Identifieur interne : 001A58 ( Pmc/Checkpoint ); précédent : 001A57; suivant : 001A59Difficult laryngoscopy and intubation in the Indian population: An assessment of anatomical and clinical risk factors
Auteurs : Smita Prakash [Inde] ; Amitabh Kumar [Inde] ; Shyam Bhandari [Inde] ; Parul Mullick [Inde] ; Rajvir Singh [Qatar] ; Anoop Raj Gogia [Inde]Source :
- Indian Journal of Anaesthesia [ 0019-5049 ] ; 2013.
Abstract
Differences in patient characteristics due to race or ethnicity may influence the incidence of difficult airway. Our purpose was to determine the incidence of difficult laryngoscopy and intubation, as well as the anatomical features and clinical risk factors that influence them, in the Indian population.
In 330 adult patients receiving general anaesthesia with tracheal intubation, airway characteristics and clinical factors were determined and their association with difficult laryngoscopy (Cormack and Lehane grade 3 and 4) was analysed. Intubation Difficulty Scale score was used to identify degree of difficult laryngoscopy.
The incidence of difficult laryngoscopy and intubation was 9.7% and 4.5%, respectively. Univariate analysis showed that increasing age and weight, male gender, modified Mallampati class (MMC) 3 and 4 in sitting and supine positions, inter-incisor distance (IID) ≤3.5 cm, thyromental (TMD) and sternomental distance, ratio of height and TMD, short neck, limited mandibular protrusion, decreased range of neck movement, history of snoring, receding mandible and cervical spondylosis were associated with difficult laryngoscopy. Multivariate analysis identified four variables that were independently associated with difficult laryngoscopy: MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring.
We found an incidence of 9.7% and 4.5% for difficult laryngoscopy and difficult intubation, respectively, in Indian patients with apparently normal airways. MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring were independently related to difficult laryngoscopy. There was a high incidence (48.5%) of minor difficulty in intubation.
Url:
DOI: 10.4103/0019-5049.123329
PubMed: 24403616
PubMed Central: 3883391
Affiliations:
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<author><name sortKey="Gogia, Anoop Raj" sort="Gogia, Anoop Raj" uniqKey="Gogia A" first="Anoop Raj" last="Gogia">Anoop Raj Gogia</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Difficult laryngoscopy and intubation in the Indian population: An assessment of anatomical and clinical risk factors</title>
<author><name sortKey="Prakash, Smita" sort="Prakash, Smita" uniqKey="Prakash S" first="Smita" last="Prakash">Smita Prakash</name>
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<author><name sortKey="Kumar, Amitabh" sort="Kumar, Amitabh" uniqKey="Kumar A" first="Amitabh" last="Kumar">Amitabh Kumar</name>
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<author><name sortKey="Bhandari, Shyam" sort="Bhandari, Shyam" uniqKey="Bhandari S" first="Shyam" last="Bhandari">Shyam Bhandari</name>
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<author><name sortKey="Mullick, Parul" sort="Mullick, Parul" uniqKey="Mullick P" first="Parul" last="Mullick">Parul Mullick</name>
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<author><name sortKey="Gogia, Anoop Raj" sort="Gogia, Anoop Raj" uniqKey="Gogia A" first="Anoop Raj" last="Gogia">Anoop Raj Gogia</name>
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<series><title level="j">Indian Journal of Anaesthesia</title>
<idno type="ISSN">0019-5049</idno>
<idno type="eISSN">0976-2817</idno>
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<front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background and Aim:</title>
<p>Differences in patient characteristics due to race or ethnicity may influence the incidence of difficult airway. Our purpose was to determine the incidence of difficult laryngoscopy and intubation, as well as the anatomical features and clinical risk factors that influence them, in the Indian population.</p>
</sec>
<sec id="st2"><title>Methods:</title>
<p>In 330 adult patients receiving general anaesthesia with tracheal intubation, airway characteristics and clinical factors were determined and their association with difficult laryngoscopy (Cormack and Lehane grade 3 and 4) was analysed. Intubation Difficulty Scale score was used to identify degree of difficult laryngoscopy.</p>
</sec>
<sec id="st3"><title>Results:</title>
<p>The incidence of difficult laryngoscopy and intubation was 9.7% and 4.5%, respectively. Univariate analysis showed that increasing age and weight, male gender, modified Mallampati class (MMC) 3 and 4 in sitting and supine positions, inter-incisor distance (IID) ≤3.5 cm, thyromental (TMD) and sternomental distance, ratio of height and TMD, short neck, limited mandibular protrusion, decreased range of neck movement, history of snoring, receding mandible and cervical spondylosis were associated with difficult laryngoscopy. Multivariate analysis identified four variables that were independently associated with difficult laryngoscopy: MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring.</p>
</sec>
<sec id="st4"><title>Conclusions:</title>
<p>We found an incidence of 9.7% and 4.5% for difficult laryngoscopy and difficult intubation, respectively, in Indian patients with apparently normal airways. MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring were independently related to difficult laryngoscopy. There was a high incidence (48.5%) of minor difficulty in intubation.</p>
</sec>
</div>
</front>
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</TEI>
<pmc article-type="other"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Indian J Anaesth</journal-id>
<journal-id journal-id-type="iso-abbrev">Indian J Anaesth</journal-id>
<journal-id journal-id-type="publisher-id">IJA</journal-id>
<journal-title-group><journal-title>Indian Journal of Anaesthesia</journal-title>
</journal-title-group>
<issn pub-type="ppub">0019-5049</issn>
<issn pub-type="epub">0976-2817</issn>
<publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name>
<publisher-loc>India</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">24403616</article-id>
<article-id pub-id-type="pmc">3883391</article-id>
<article-id pub-id-type="publisher-id">IJA-57-569</article-id>
<article-id pub-id-type="doi">10.4103/0019-5049.123329</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Clinical Investigation</subject>
</subj-group>
</article-categories>
<title-group><article-title>Difficult laryngoscopy and intubation in the Indian population: An assessment of anatomical and clinical risk factors</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Prakash</surname>
<given-names>Smita</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kumar</surname>
<given-names>Amitabh</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bhandari</surname>
<given-names>Shyam</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mullick</surname>
<given-names>Parul</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Singh</surname>
<given-names>Rajvir</given-names>
</name>
<xref ref-type="aff" rid="aff2">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gogia</surname>
<given-names>Anoop Raj</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
</contrib-group>
<aff id="aff1">Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India</aff>
<aff id="aff2"><label>1</label>
Medical Research Cardiology, HMC, Doha, Qatar</aff>
<author-notes><corresp id="cor1"><bold>Address for correspondence:</bold>
Dr. Smita Prakash, C 17 HUDCO Place, New Delhi - 110 049, India. E-mail: <email xlink:href="drsunilprakash@gmail.com">drsunilprakash@gmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><season>Nov-Dec</season>
<year>2013</year>
</pub-date>
<volume>57</volume>
<issue>6</issue>
<fpage>569</fpage>
<lpage>575</lpage>
<permissions><copyright-statement>Copyright: © Indian Journal of Anaesthesia</copyright-statement>
<copyright-year>2013</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><sec id="st1"><title>Background and Aim:</title>
<p>Differences in patient characteristics due to race or ethnicity may influence the incidence of difficult airway. Our purpose was to determine the incidence of difficult laryngoscopy and intubation, as well as the anatomical features and clinical risk factors that influence them, in the Indian population.</p>
</sec>
<sec id="st2"><title>Methods:</title>
<p>In 330 adult patients receiving general anaesthesia with tracheal intubation, airway characteristics and clinical factors were determined and their association with difficult laryngoscopy (Cormack and Lehane grade 3 and 4) was analysed. Intubation Difficulty Scale score was used to identify degree of difficult laryngoscopy.</p>
</sec>
<sec id="st3"><title>Results:</title>
<p>The incidence of difficult laryngoscopy and intubation was 9.7% and 4.5%, respectively. Univariate analysis showed that increasing age and weight, male gender, modified Mallampati class (MMC) 3 and 4 in sitting and supine positions, inter-incisor distance (IID) ≤3.5 cm, thyromental (TMD) and sternomental distance, ratio of height and TMD, short neck, limited mandibular protrusion, decreased range of neck movement, history of snoring, receding mandible and cervical spondylosis were associated with difficult laryngoscopy. Multivariate analysis identified four variables that were independently associated with difficult laryngoscopy: MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring.</p>
</sec>
<sec id="st4"><title>Conclusions:</title>
<p>We found an incidence of 9.7% and 4.5% for difficult laryngoscopy and difficult intubation, respectively, in Indian patients with apparently normal airways. MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring were independently related to difficult laryngoscopy. There was a high incidence (48.5%) of minor difficulty in intubation.</p>
</sec>
</abstract>
<kwd-group><kwd>Airway evaluation</kwd>
<kwd>difficult intubation</kwd>
<kwd>difficult laryngoscopy</kwd>
<kwd>intubation difficulty scale</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Inde</li>
<li>Qatar</li>
</country>
</list>
<tree><country name="Inde"><noRegion><name sortKey="Prakash, Smita" sort="Prakash, Smita" uniqKey="Prakash S" first="Smita" last="Prakash">Smita Prakash</name>
</noRegion>
<name sortKey="Bhandari, Shyam" sort="Bhandari, Shyam" uniqKey="Bhandari S" first="Shyam" last="Bhandari">Shyam Bhandari</name>
<name sortKey="Gogia, Anoop Raj" sort="Gogia, Anoop Raj" uniqKey="Gogia A" first="Anoop Raj" last="Gogia">Anoop Raj Gogia</name>
<name sortKey="Kumar, Amitabh" sort="Kumar, Amitabh" uniqKey="Kumar A" first="Amitabh" last="Kumar">Amitabh Kumar</name>
<name sortKey="Mullick, Parul" sort="Mullick, Parul" uniqKey="Mullick P" first="Parul" last="Mullick">Parul Mullick</name>
</country>
<country name="Qatar"><noRegion><name sortKey="Singh, Rajvir" sort="Singh, Rajvir" uniqKey="Singh R" first="Rajvir" last="Singh">Rajvir Singh</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>
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