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Ollaek M, Abo Elela S, Ahmed A, Abdel Rahman N, ElKholy G, Gorgy A, Reda I, Mohamed D. Thyromental height test as a predictor of difficult airway. Single test versus multivariate predictive models. A cohort study. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2139107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mohamed Ollaek
- Department of Anaesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, Cairo, Egypt
| | - Shady Abo Elela
- Department of Anaesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, Cairo, Egypt
| | - Abeer Ahmed
- Department of Anaesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, Cairo, Egypt
| | - Neamat Abdel Rahman
- Department of Anaesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, Cairo, Egypt
| | - Gehan ElKholy
- Department of Anaesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, Cairo, Egypt
| | - Antony Gorgy
- Department of Anaesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, Cairo, Egypt
| | - Islam Reda
- Department of Anaesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, Cairo, Egypt
| | - Dina Mohamed
- Department of Anaesthesiology, Surgical ICU and pain management, Kasr Alainy Faculty of Medicine, Cairo University- Egypt, Cairo, Egypt
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Abdelhamid BM, Ahmed A, Osman S, Abdel Azeim S, Mekawy N, Saad D. Accuracy of sternomental displacement test and thyromental height test as a predictive measure for difficult airway in elderly surgical patients: a prospective cohort study. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2133746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Bassant Mohamed Abdelhamid
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr-Alainy Faculty of Medicine, Cairo University, Egypt
- Department of anaesthesiology, Armed forces college of medicine, Egypt
| | - Abeer Ahmed
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr-Alainy Faculty of Medicine, Cairo University, Egypt
| | - Safinaz Osman
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr-Alainy Faculty of Medicine, Cairo University, Egypt
| | - Samar Abdel Azeim
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr-Alainy Faculty of Medicine, Cairo University, Egypt
| | - Nevan Mekawy
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr-Alainy Faculty of Medicine, Cairo University, Egypt
| | - Dalia Saad
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr-Alainy Faculty of Medicine, Cairo University, Egypt
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Use of the Thyromental Height Test for Prediction of Difficult Laryngoscopy: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11164906. [PMID: 36013145 PMCID: PMC9409656 DOI: 10.3390/jcm11164906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
The thyromental height test (TMHT) has been proposed as a novel single clinical test for predicting difficult laryngoscopy (DL), though consequent studies have put forward various estimates when verifying its reliability. This systematic review and meta-analysis aimed to provide a comprehensive evaluation of the predictive value of TMHT for DL. A computerized search of CNKI, CQVIP, EBSCO, PubMed, SinoMed, and Wanfang Data was conducted on 1 June 2022. Prospective cohort studies reporting diagnostic properties of TMHT in relation to Cormack and Lehane grading in patients aged more than 16 years, either sex, scheduled for surgery under general anesthesia, requiring tracheal intubation with direct laryngoscopy were included in this analysis. Data was extracted or calculated, and meta-analysis was done by the Stata MIDAS module. A total of 23 studies with 5896 patients were included in this analysis. Summary estimates of all included studies are as follows: sensitivity 74% (95% CI, 68-79%); specificity 88% (95% CI, 81-92%); diagnostic odd ratio, 20 (95% CI, 10-40); positive likelihood ratio, 5.9 (95% CI, 3.6-9.6); and negative likelihood ratio, 0.30 (95% CI, 0.23-0.39). Summary sensitivity and specificity for studies with a prespecified threshold were 82% (95% CI, 71-89%) and 94% (95% CI, 87-98%), respectively. The estimated area under curve (AUC) was 85% (95% CI, 81-88%). There was no significant threshold effect but significant heterogeneity in both sensitivity and specificity. Heterogeneity in sensitivity became insignificant after removing two outliers of sensitivity analysis. It is concluded that THMT has an overall optimal predictive value for DL in adult patients with diverse ethnicity and various risk factors, displaying better predictive values in a large patient population comparing to other recent reported bedside assessments and a previous meta-analysis. As significant heterogeneity brought by un-standardized application of external laryngeal manipulations in the included studies may have biased the results of this meta-analysis, the actual predictive value of TMHT for DL still awaits further studies with good designs and large sample sizes for better determination.
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Ahmed AM, Zaky MN, El-Mekawy NM, Ollaek MA, Sami WM, Mohamed DM. Evaluation of thyromental height test in prediction of difficult airway in obese surgical patients: An observational study. Indian J Anaesth 2022; 65:880-885. [PMID: 35221360 PMCID: PMC8820326 DOI: 10.4103/ija.ija_675_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/20/2021] [Accepted: 12/05/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Thyromental height test (TMHT) has revealed good potentials for predicting difficult laryngoscopy view (DLV) in non-obese patients, but its accuracy in obese patients is not evident. This study aimed to assess the validity of TMHT as a predictor of DLV in obese surgical patients. METHODS 105 patients, aged 18-60 years, with body mass index (BMI) >30 kg/m2, scheduled for elective surgeries under general anaesthesia with an endotracheal tube inserted using conventional laryngoscope were included. Airway was assessed with TMHT, modified Mallampati test (MMT), neck circumference (NC) and NC/TMHT ratio. The DLV was defined as Cormack-Lehane grade ≥3. The primary endpoint was the validity of TMHT as a predictor of DLV. The secondary endpoints were to compare the accuracy of TMHT with that of the NC, MMT and NC/TMHT ratio as predictors of the difficult airway. RESULTS The BMI was 43.7 ± 6.6 kg/m2. The DLV cases were 23/105 (21.9%). The MMT, TMHT and NC/TMHT ratio had the best predictive ability of DLV with areas under receiver operating characteristic curve of 0.91, 0.92 and 0.80; at cut-off values >2, <47 mm and >7.9, respectively. MMT and TMHT were the only predictors of DLV by multivariate analysis. CONCLUSION In obese surgical patients, TMHT is an excellent predictor of DLV when the cut-off value is <47 mm.
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Affiliation(s)
- Abeer M Ahmed
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Monica N Zaky
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Nevan M El-Mekawy
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Mohamed A Ollaek
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Wael M Sami
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Dina M Mohamed
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
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Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Greif R, Klock PA, Mercier D, Myatra SN, O'Sullivan EP, Rosenblatt WH, Sorbello M, Tung A. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022; 136:31-81. [PMID: 34762729 DOI: 10.1097/aln.0000000000004002] [Citation(s) in RCA: 317] [Impact Index Per Article: 158.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
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Carvalho CCD, Santos Neto JM, Orange FAD. Predictive performance of thyromental height for difficult laryngoscopies in adults: a systematic review and meta-analysis. Braz J Anesthesiol 2021:S0104-0014(21)00271-2. [PMID: 34252454 PMCID: PMC10362459 DOI: 10.1016/j.bjane.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/07/2021] [Accepted: 06/20/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Thyromental height (TMH) was first reported as a great single test for prediction of difficult laryngoscopies, although further studies have shown variable estimates of its accuracy. We thus performed this meta-analysis to summarize the predictive values of TMH mainly for prediction of difficult laryngoscopies. METHODS A search in PubMed, EMBASE, LILACS, and Scielo was conducted in June 2020. We included prospective cohorts fully reported with patients ≥ 16 years old, providing data on predictive values of TMH for prediction of either difficult laryngoscopies or difficult intubations. Diagnostic properties and association between TMH and Cormack and Lehanes's classification by direct laryngoscopy were evaluated. A random-effects meta-analysis using hierarchical models was performed. RESULTS Eight studies evaluating 2844 patients were included. All included studies had high risk of bias and low concern regarding applicability. There was significant heterogeneity among the studies. The pooled diagnostic odds ratio (DOR) and positive (LR+) and negative (LR-) likelihood ratios were as follows: DOR, 57.94 (95% CI: 18.19-184.55); LR+, 11.32 (95% CI: 4.28-29.92); and LR-, 0.23 (95% CI: 0.15-0.35). Summary sensitivity and specificity for studies with common threshold were 82.6 (95% CI: 74-88.8%) and 93.5 (95% CI: 79-98.2%), respectively. The estimated AUC was 81.1%. CONCLUSION TMH arises as a good predictor of difficult laryngoscopies in adult patients from diverse populations presenting better predictive values than most previously reported bedside tests. However, the high risk of bias throughout the studies may have skewed the results of the individual research as well as the summary points of the present meta-analysis.
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Affiliation(s)
| | - Jayme Marques Santos Neto
- Universidade Federal de Pernambuco (UFPE), Hospital das Clínicas, Department of Anesthesia, Recife, PE, Brazil
| | - Flávia Augusta de Orange
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Department of Post-graduation, Recife, PE, Brazil
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Kim JH, Kim H, Jang JS, Hwang SM, Lim SY, Lee JJ, Kwon YS. Development and validation of a difficult laryngoscopy prediction model using machine learning of neck circumference and thyromental height. BMC Anesthesiol 2021; 21:125. [PMID: 33882838 PMCID: PMC8059322 DOI: 10.1186/s12871-021-01343-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Predicting difficult airway is challengeable in patients with limited airway evaluation. The aim of this study is to develop and validate a model that predicts difficult laryngoscopy by machine learning of neck circumference and thyromental height as predictors that can be used even for patients with limited airway evaluation. Methods Variables for prediction of difficulty laryngoscopy included age, sex, height, weight, body mass index, neck circumference, and thyromental distance. Difficult laryngoscopy was defined as Grade 3 and 4 by the Cormack-Lehane classification. The preanesthesia and anesthesia data of 1677 patients who had undergone general anesthesia at a single center were collected. The data set was randomly stratified into a training set (80%) and a test set (20%), with equal distribution of difficulty laryngoscopy. The training data sets were trained with five algorithms (logistic regression, multilayer perceptron, random forest, extreme gradient boosting, and light gradient boosting machine). The prediction models were validated through a test set. Results The model’s performance using random forest was best (area under receiver operating characteristic curve = 0.79 [95% confidence interval: 0.72–0.86], area under precision-recall curve = 0.32 [95% confidence interval: 0.27–0.37]). Conclusions Machine learning can predict difficult laryngoscopy through a combination of several predictors including neck circumference and thyromental height. The performance of the model can be improved with more data, a new variable and combination of models. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01343-4.
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Affiliation(s)
- Jong Ho Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon, 24253, South Korea.,Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea
| | - Haewon Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon, 24253, South Korea
| | - Ji Su Jang
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon, 24253, South Korea
| | - Sung Mi Hwang
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon, 24253, South Korea
| | - So Young Lim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon, 24253, South Korea
| | - Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon, 24253, South Korea.,Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea
| | - Young Suk Kwon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon, 24253, South Korea. .,Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea.
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Panjiar P, Bhat KM, Yousuf I, Kochhar A, Ralli T. Study comparing different airway assessment tests in predicting difficult laryngoscopy: A prospective study in geriatric patients. Indian J Anaesth 2021; 65:309-315. [PMID: 34103745 PMCID: PMC8174600 DOI: 10.4103/ija.ija_1413_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/23/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023] Open
Abstract
Background and Aims Limited studies are available comparing diagnostic accuracy of various airway predictors in geriatric patients. We conducted this study with primary aim to evaluate and validate the predictive value of 'standard airway predictors' like modified Mallampati test, thyromental distance (TMD), sternomental distance, neck movement (NM), mouth opening (MO), dentition and 'new airway predictors' like upper lip bite test (ULBT), ratio of height to thyromental distance and thyromental height test (TMHT) for predicting difficult laryngoscopy in geriatric patients. Methods This prospective, observational study was conducted on 140 patients above 65 years of age of either sex, scheduled for elective surgery under general anaesthesia requiring endotracheal intubation. The age, weight, height, body mass index (BMI) and airway parameters were recorded. The laryngoscopic view was assessed by modified Cormack-Lehane scale. Standard formulae were used to calculate validity indexes. Results The incidence of difficult larygoscopy found in our study was 25%. The mean age of our study population was 69.37 ± 4.23 years. TMD exhibited the highest sensitivity (80%) and negative predictive value (NPV) (91.86%) as compared to other studied airway predictors. The positive predictive value (PPV) of ULBT was 100%. Moreover, ULBT exhibited highest accuracy (82.14%) and odds ratio (86.88) and high specificity (91.30%) for predicting difficult laryngoscopy in geriatric patients. NM and TMHT also exhibited high accuracy (77.85%, 77.14%) and PPV (59.09%, 52.94%). Conclusions TMD and ULBT both showed good predictive value in diagnosing difficult laryngoscopy in geriatric patients. Furthermore, NM and TMHT also exhibited higher diagnostic accuracy in predicting difficult airway in these patients.
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Affiliation(s)
- Pratibha Panjiar
- Department of Anaesthesiology, Pain Medicine and Critical Care, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Kharat Mohammed Bhat
- Department of Anaesthesiology, Pain Medicine and Critical Care, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Irshad Yousuf
- Department of Anaesthesiology, Pain Medicine and Critical Care, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Anjali Kochhar
- Department of Anaesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjang Hospital, Jamia Hamdard, New Delhi, India
| | - Tanya Ralli
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
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Gao Y, Liu SH, Xue FS. Accuracy of predictive factors for difficult intubation. J Anesth 2020; 34:630. [PMID: 32221687 DOI: 10.1007/s00540-020-02771-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/21/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Ying Gao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Shao-Hua Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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Mostafa M, Hasanin A. A reply to a letter. J Anesth 2020; 34:631. [PMID: 32232661 DOI: 10.1007/s00540-020-02772-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt.
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
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