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Lateral neck radiography for prediction of difficult orotracheal intubation

Published online by Cambridge University Press:  26 August 2005

H. Kamalipour ,
M. Bagheri ,
K. Kamali ,
A. Taleie  and
H. Yarmohammadi
H. Kamalipour
Affiliation:
Shiraz University of Medical Sciences, Faghihi Hospital, Department of Anesthesiology, Shiraz, Iran
M. Bagheri
Affiliation:
Shiraz University of Medical Sciences, Nemazee Hospital, Department of Radiology, Shiraz, Iran
K. Kamali
Affiliation:
Shiraz University of Medical Sciences, Nemazee Hospital, Department of Radiology, Shiraz, Iran
A. Taleie
Affiliation:
Shiraz University of Medical Sciences, Faghihi Hospital, Department of Anesthesiology, Shiraz, Iran
H. Yarmohammadi
Affiliation:
Shiraz University of Medical Sciences, Faghihi Hospital, Department of Surgery, Shiraz, Iran
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Extract

Summary

Background and objectives: Failed endotracheal intubation is a principal cause of morbidity and mortality in anesthetized patients. The aim of this study was to investigate the efficiency of lateral neck radiography in predicting difficult intubation. Methods: In a prospective triple-blind study, 100 patients (aged 18–89 yr), scheduled for elective surgery were randomly selected. Lateral neck X-ray was obtained from each of the patients before operation. Several angles and parameters on the X-ray were proposed to illustrate a relationship with easy or difficult intubation. A radiologist recorded these angles before the operation. An anaesthesiologist also determined the Mallampati score preoperation. At the time of intubation, two other anesthesiologists performed a laryngoscopy and, according to established criteria, identified the patients as easy or difficult intubation. The results were then compared with each other. Results: Fifteen patients were identified as having difficult intubation (laryngoscopy Grades III and IV). Sensitivity and specificity of the Mallampati Class test were 26% and 100%, respectively. The sensitivity and specificity of the lateral neck X-ray for three measured angles were 100%. The positive and negative predictive values (NPVs) for those angles were 100% and for Mallampati classification were 100% and 80%, respectively. Conclusions: Compared to the Mallampati Class test, our method of analyzing the lateral X-ray, although not as easy and universally applicable as Mallampati Class test, proved to be a suitable method for predicting difficult intubation.

Keywords

INTUBATION, INTRATRACHEAL, prediction, classification, MallampatiRADIOGRAPHY, neck, lateralLARYNGOSCOPY, direct
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 9 , September 2005 , pp. 689 - 693
Copyright
© 2005 European Society of Anaesthesiology

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