Anest. intenziv. Med. 2012;23(2):69-74

Validation of factors predicting difficult intubationAnaesthesiology - Original Paper

Fritscherová Šárka^1,*, Dostálová Kateřina¹, Koutná Jiřina^1,2, Janout Vladimír³, Zapletalová Jana^4,5, Adamus Milan^1,2

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Olomouc

² Lékařská fakulta Univerzity Palackého v Olomouci

³ Ústav preventivního lékařství, Lékařská fakulta Univerzity Palackého v Olomouci

⁴ Ústav lékařské biofyziky, Lékařská fakulta Univerzity Palackého v Olomouci

⁵ Ústav molekulární a translační medicíny, Lékařská fakulta Univerzity Palackého v Olomouci

Objective:
Validation of three pre-operative examinations which could predict difficult intubation (Interincisor Gap, Thyromental Distance, Temporomandibular Joint Movement).

Design:
Prospective blinded study.
Setting:
Department of Anaesthesiology, Resuscitation and Intensive Medicine, University Hospital.

Materials and methods:
Thyromental distance, interincisor gap and temporomandibular joint movement were measured during the pre-anaesthetic examination in all patients intended for general anaesthesia with tracheal intubation. The Cormack - Lehan laryngoscopic view in Cook's modification was evaluated by the anaesthesiologist on induction of anaesthesia. The correlation between the measured values of the three predictors and difficult intubation was evaluated statistically.

Results:
We examined 313 patients, in 18 of them we described laryngoscopic view associated with difficult airway management, i.e. only epiglottis or root of the tongue visible. Statistical analysis confirmed that patients with laryngoscopic views associated with difficult intubation had shorter thyromental distance (p = 0.013) and interincisor gap (p = 0.001), and worse temporomandibular joint movement (p = 0.0001) compared to patients with parts of or whole vocal cords visible during laryngoscopy.

Conclusion:
Interincisor gap, thyromental distance and temporomandibular joint movement assessment are quick, easy to perform and technically undemanding tests for prediction of difficult intubation. The tests are not absolutely reliable but they can draw attention to patients with possible difficult airway.

Keywords: difficult tracheal intubation; prediction; interincisor gap; thyromental distance; temporomandibular joint movement

Received: January 23, 2012; Accepted: March 11, 2012; Published: April 1, 2012  Show citation