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Prediction of difficult tracheal intubation in Turkish patients: a multi-center methodological study

Published online by Cambridge University Press:  01 December 2007

T. S. Yildiz ,
F. Korkmaz ,
M. Solak ,
K. Toker ,
N. Erciyes ,
F. Bayrak ,
S. Ganidagli ,
M. Tekin ,
M. Kızılkaya  and
B. Karslı
...Show all authors
T. S. Yildiz*
Affiliation:
University of Kocaeli, School of Medicine, Department of Anaesthesiology, Kocaeli, Turkey
F. Korkmaz
Affiliation:
University of Kocatepe, School of Medicine, Department of Anaesthesiology, Afyon, Turkey
M. Solak
Affiliation:
University of Kocaeli, School of Medicine, Department of Anaesthesiology, Kocaeli, Turkey
K. Toker
Affiliation:
University of Kocaeli, School of Medicine, Department of Anaesthesiology, Kocaeli, Turkey
N. Erciyes
Affiliation:
Karadeniz Technical University, School of Medicine, Department of Anaesthesiology, Trabzon, Turkey
F. Bayrak
Affiliation:
University of Trakya, School of Medicine, Department of Anaesthesiology, Edirne, Turkey
S. Ganidagli
Affiliation:
University of Harran, School of Medicine, Department of Anaesthesiology, Sanliurfa, Turkey
M. Tekin
Affiliation:
University of Yuzuncu Yıl, School of Medicine, Department of Anaesthesiology, Van, Turkey
M. Kızılkaya
Affiliation:
University of Ataturk, School of Medicine, Department of Anaesthesiology, Erzurum, Turkey
B. Karslı
Affiliation:
University of Akdeniz, School of Medicine, Department of Algology, Antalya, Turkey
A. Turan
Affiliation:
University of Louisville, Outcomes Research Institute, Department of Anaesthesiology, Kentucky, USA
U. Ozcan
Affiliation:
University of Kocaeli, School of Medicine, Department of Public Health Sciences, Kocaeli, Turkey
*
Correspondence to: Tulay Sahin Yildiz, PK: 17, Derince, 41900, Kocaeli/Turkey. E-mails: tulaysahin00@yahoo.com, tsyildiz@yahoo.com; Tel: +90 262 3039499; Fax: +90 262 3257363
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Summary

Background and objective

Preoperative evaluation is important in the detection of patients at risk for difficult airway management. It is still unclear whether true prediction is possible and which variables should be chosen for evaluation. The aim of this prospective, multi-centre study was to investigate the incidence of difficult intubation, the sensitivity and positive predictive values of clinical screening tests and whether combining two or more of these tests will improve the prediction of difficult intubation in Turkish patients.

Methods

Seven study sites from six regions in Turkey participated in this study. One thousand six hundred and seventy-four ASA physical status I–III patients, scheduled to undergo elective surgery under general anaesthesia, were included.

Results

The incidence of difficult intubation was 4.8% and increased with age (P < 0.05). The incidence of difficult intubation was significantly higher in patients who had a Mallampati III or IV score, a decreased average thyromental and sternomental distance, decreased mouth opening, or decreased protrusion of the mandible (P < 0.05). Mouth opening and Mallampati III–IV were found to be the most sensitive criteria when used alone (43% and 35%, respectively). Combination of tests did not improve these results.

Conclusions

There is still no individual test or a combination of tests that predict difficult intubations accurately. Tests with higher specificity despite low positive predictive value are needed.

Keywords

ANAESTHESIA GENERALINTUBATIONLARYNGOSCOPYAIRWAY ASSESSMENT TESTS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 12 , December 2007 , pp. 1034 - 1040
Copyright
Copyright © European Society of Anaesthesiology 2007

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