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Marković D, Šurbatović M, Milisavljević D, Marjanović V, Stošić B, Stanković M. Prediction of a Difficult Airway Using the ARNE Score and Flexible Laryngoscopy in Patients with Laryngeal Pathology. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:619. [PMID: 38674265 PMCID: PMC11051977 DOI: 10.3390/medicina60040619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: The ARNE score was developed for the prediction of a difficult airway for both general and ear, nose and throat (ENT) surgery with a universal cut-off value. We tested the accuracy of this score in the case of laryngeal surgery and provided an insight into its effects in combination with flexible laryngoscopy. Materials and Methods: This prospective pilot clinical study included 100 patients who were being scheduled for microscopic laryngeal surgery. We calculated the ARNE score for every patient, and flexible laryngoscopy was provided preoperative. Difficult intubation was assessed according to the intubation difficulty score (IDS). Results: A total of 33% patients had difficult intubation according to the IDS. The ARNE score showed limited accuracy for the prediction of difficult intubation in laryngology with p < 0.0001 and an AUC of 0.784. Flexible laryngoscopy also showed limitations when used as an independent parameter with p < 0.0001 and an AUC of 0.766. We defined a new cut-off value of 15.50 for laryngology, according to the AUC. After the patients were divided into two groups, according to the new cut-off value and provided cut-off value, the AUC improved to 0.707 from 0.619, respectively. Flexible laryngoscopy improved the prediction model of the ARNE score to an AUC of 0.882 and of the new cut-off value to an AUC of 0.833. Conclusions: It is recommended to use flexible laryngoscopy together with the ARNE score in difficult airway prediction in patients with laryngeal pathology. Also, the universally recommended cut-off value of 11 cannot be effectively used in laryngology, and a new cut-off value of 15.50 is recommended.
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Affiliation(s)
- Danica Marković
- Clinic for Anesthesiology and Intensive Therapy, University Clinical Center in Niš, 18000 Niš, Serbia; (V.M.); (B.S.)
| | - Maja Šurbatović
- Clinic for Anesthesiology and Intensive Therapy, Military Medical Academy, 11000 Belgrade, Serbia;
- Faculty of Medicine of the Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
| | - Dušan Milisavljević
- Otolaryngology Clinic, University Clinical Center in Niš, 18000 Niš, Serbia; (D.M.); (M.S.)
- Department Otorhinolaryngology, Faculty of Medicine, Univeristy in Niš, 18000 Niš, Serbia
| | - Vesna Marjanović
- Clinic for Anesthesiology and Intensive Therapy, University Clinical Center in Niš, 18000 Niš, Serbia; (V.M.); (B.S.)
- Department Surgery and Anesthesiology and Reanimatology, Faculty of Medicine, University in Niš, 18000 Niš, Serbia
| | - Biljana Stošić
- Clinic for Anesthesiology and Intensive Therapy, University Clinical Center in Niš, 18000 Niš, Serbia; (V.M.); (B.S.)
- Department Surgery and Anesthesiology and Reanimatology, Faculty of Medicine, University in Niš, 18000 Niš, Serbia
| | - Milan Stanković
- Otolaryngology Clinic, University Clinical Center in Niš, 18000 Niš, Serbia; (D.M.); (M.S.)
- Department Otorhinolaryngology, Faculty of Medicine, Univeristy in Niš, 18000 Niš, Serbia
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Huang AE, Camiré D, Hwang PH, Nekhendzy V. Difficult Tracheal Intubation and Airway Outcomes after Radiation for Nasopharyngeal Carcinoma. Laryngoscope 2024; 134:120-126. [PMID: 37249176 DOI: 10.1002/lary.30767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/07/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The aim of the study was to characterize the incidence and management of difficult tracheal intubations (DTIs) in nasopharyngeal carcinoma (NPC) after primary radiation therapy (RT). METHODS The study was a retrospective review of airway assessment and outcomes in post-RT NPC patients. Primary analysis was performed on patients who underwent post-RT procedures, who were split into non-DTI and DTI groups. Patients were classified as DTI if they (i) required >1 attempt to intubate, (ii) failed to be intubated, or (iii) experienced complications attributed to airway management. Secondary analysis was performed between patients who underwent post-RT procedures (procedure group) and those who did not (control group). RESULTS One-hundred and fifty patients were included, and 71.3% underwent post-RT procedures, with no differences in characteristics between the procedure and control groups. One-hundred and fifty procedures were identified, and 28.0% were categorized as DTI. There was no difference in patient characteristics or airway assessment measures between DTI and non-DTI groups. Regression analysis revealed concurrent cervical mobility restriction, and trismus increased DTI incidence by 7.1-fold (p = 0.011). Being non-White was an independent predictor of DTI. The incidence of high-grade intraoperative laryngoscopic view was lower in the non-DTI compared to the DTI group (20.4% vs. 64.3%, p < 0.0001). Failure to intubate occurred in 2.0% of cases, and 6.0% cases had perioperative complications. Based on preoperative assessment, sensitivity of predicting DTI was 54.8% and specificity was 63.9%. CONCLUSION NPC patients frequently undergo post-RT procedures requiring complex airway management. Rates of DTI and failed intubation are significantly higher than those in the general surgical population, and the ability to predict DTI with standard preoperative airway measures is poor. LEVEL OF EVIDENCE 4 Laryngoscope, 134:120-126, 2024.
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Affiliation(s)
- Alice E Huang
- Stanford Hospital, Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California, USA
| | - Daenis Camiré
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
| | - Peter H Hwang
- Stanford Hospital, Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California, USA
| | - Vladimir Nekhendzy
- Stanford Hospital, Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
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Tasli H, Karaman NE, Isler D, Subasi B. A Predictor of Difficult Airway: The Tasli Classification in Transnasal Flexible Laryngoscopy. J Voice 2023; 37:945-950. [PMID: 34315651 DOI: 10.1016/j.jvoice.2021.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Difficult airway is defined as difficulty or failure in one or more steps in upper airway management. Evaluation of the upper airway with physical examination methods and endoscopic devices is crucial in predicting difficult airway. The aim of this study was to evaluate bedside tests, Cormack Lehane (CL) and Tasli Classification (TC) scores of the patients and it was aimed to reveal the role of TC which will be performed preoperatively as a predictor of difficult tracheal intubation (DTI). METHODS The study included a total of 98 patients who underwent surgical treatment under general anesthesia. Demographic data, including age, gender, and body mass index (BMI), and bedside tests consisting Modified Mallampati Classification (MMC), thyromental (TD) and sternomental (SD) distances, neck circumference (NC), interincisor distance (IID), CL and TC were recorded. RESULTS Evaluation was made of 64 (65.3%) male and 34 (34.7%) female patients ranging in age from 18 to 84 years (mean age: 50.35 ± 0.47 years). The successfully intubated patients (SIP) group comprised 68 (69.4%) patients, and the difficult intubation patients (DIP) group, 30 (30.6%). According to CL, the numbers of SIP and DIP constituting grade 1 was 29 (42.6%) and one (3.3%); grade 2a was 29 (42.6%) and one (3.3%); grade 2b was eight (11.8%) and three (10%); grade 3a was one (1.5%) and six (20%); grade 3b was one (1.5%) and 14 (46.7%) respectively. Grade 4 was only detected in the DIP group in 5 (16.7%) patients. According to TC, the numbers of SIP and DIP constituting grade 1 was 20 (29.4%) and 1 (3.3%); grade 2a was 37 (54.4%) and seven (23.3%); grade 2b was 10 (14.7%) and 18 (60%); grade 3 was one (1.5%) and two (6.7%) respectively. Grade 4 was only detected in the DIP group in two (6.7%) patients. CONCLUSION The TC, CL, NC and BMI scores were higher in the DIP group and higher TC scores (grade 2b, 3, and 4) can be a predictor of difficult airway. However, it may be more beneficial to use TC as a complementary diagnostic tool with bedside tests such as NC, SM, TM and MMC, rather than used alone.
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Affiliation(s)
- Hamdi Tasli
- Kütahya University of Health Sciences, Evliya Celebi Training and Research Hospital, Department of Otolaryngology, Head and Neck Surgery, Kütahya, Turkey.
| | - Nesibe Esra Karaman
- Kütahya University of Health Sciences, Evliya Celebi Training and Research Hospital, Department of Otolaryngology, Head and Neck Surgery, Kütahya, Turkey
| | - Dilber Isler
- Kütahya University of Health Sciences, Evliya Celebi Training and Research Hospital, Department of Anesthesiology, Kütahya, Turkey
| | - Bugra Subasi
- Kütahya University of Health Sciences, Evliya Celebi Training and Research Hospital, Department of Otolaryngology, Head and Neck Surgery, Kütahya, Turkey
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Sasu PB, Pansa JI, Stadlhofer R, Wünsch VA, Loock K, Buscher EK, Dankert A, Ozga AK, Zöllner C, Petzoldt M. Nasendoscopy to Predict Difficult Videolaryngoscopy: A Multivariable Model Development Study. J Clin Med 2023; 12:jcm12103433. [PMID: 37240540 DOI: 10.3390/jcm12103433] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Transnasal videoendoscopy (TVE) is the standard of care when staging pharyngolaryngeal lesions. This prospective study determined if preoperative TVE improves the prediction of difficult videolaryngoscopic intubation in adults with expected difficult airway management in addition to the Simplified Airway Risk Index (SARI). METHODS 374 anesthetics were included (252 with preoperative TVE). The primary outcome was a difficult airway alert issued by the anesthetist after Macintosh videolaryngoscopy. SARI, clinical factors (dysphagia, dysphonia, cough, stridor, sex, age and height) and TVE findings were used to fit three multivariable mixed logistic regression models; least absolute shrinkage and selection operator (LASSO) regression was used to select co-variables. RESULTS SARI predicted the primary outcome (odds ratio [OR] 1.33; 95% confidence interval [CI] 1.13-1.58). The Akaike information criterion for SARI (327.1) improved when TVE parameters were added (311.0). The Likelihood ratio test for SARI plus TVE parameters was better than for SARI plus clinical factors (p < 0.001). Vestibular fold lesions (OR 1.82; 95% CI 0.40-8.29), epiglottic lesions (OR 3.37; 0.73-15.54), pharyngeal secretion retention (OR 3.01; 1.05-8.63), restricted view on rima glottidis <50% (OR 2.13; 0.51-8.89) and ≥50% (OR 2.52; 0.44-14.56) were concerning. CONCLUSION TVE improved prediction of difficult videolaryngoscopy in addition to traditional bedside airway examinations.
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Affiliation(s)
- Phillip Brenya Sasu
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jennifer-Isabel Pansa
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Rupert Stadlhofer
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Viktor Alexander Wünsch
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Karolina Loock
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Eva Katharina Buscher
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - André Dankert
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Zöllner
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Martin Petzoldt
- Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Wang G, Bing D, Chen X, Dong P. [Applying a rigid curved video laryngoscope in laryngeal microsurgery of patients with difficult laryngeal exposure]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:463-466. [PMID: 35822366 PMCID: PMC10128495 DOI: 10.13201/j.issn.2096-7993.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Indexed: 06/15/2023]
Abstract
Objective:To test the feasibility of a rigid curved video laryngoscope in laryngeal microsurgery of patients with difficult laryngeal exposure. Methods:Thirteen patients with difficult laryngeal exposure underwent microlayngeal surgery using a new-design rigid curved video laryngoscope. The clinical data were collected and analyzed. Results:In all of the 13 patients with difficult laryngeal exposure,the fully exposure rate of glottis was 100% using a new-design rigid curved laryngoscope.But only 7 precise surgeries using our rigid curved instruments were completed successfully. Conclusion:Rigid curved laryngoscope is a useful tool to in treating patients with difficult laryngeal exposure in microlaryngeal surgery. Satisfactory glottis exposure, magnified surgical field and precise maneuver of the lesions could be achieved. But manipulation of this tool is challenging, which warrants further investigation..
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Affiliation(s)
- Guoliang Wang
- Department of Otolaryngology Head and Neck Surgery,Nanjing Medical University of Shanghai General Hospital,Shanghai,200080,China
| | - Dan Bing
- Department of Otolaryngology Head and Neck Surgery,Tongji Hospital of Huazhong University of Science and Technology
| | - Xinwei Chen
- Department of Otolaryngology Head and Neck Surgery,Nanjing Medical University of Shanghai General Hospital,Shanghai,200080,China
| | - Pin Dong
- Department of Otolaryngology Head and Neck Surgery,Nanjing Medical University of Shanghai General Hospital,Shanghai,200080,China
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Awake Intubation Techniques, and Why It Is Still an Important Skill to Master. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tsai YCM, Russotto V, Parotto M. Predicting the Difficult Airway: How Useful Are Preoperative Airway Tests? CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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: 337] [Impact Index Per Article: 168.5] [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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O'Carroll J, Endlich Y, Ahmad I. Advanced airway assessment techniques. BJA Educ 2021; 21:336-342. [PMID: 34447580 DOI: 10.1016/j.bjae.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- J O'Carroll
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Y Endlich
- Royal Adelaide Hospital and Women's & Children Hospital, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - I Ahmad
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
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A comparison of pre-operative transnasal flexible endoscopic laryngoscopy and actual laryngeal view obtained with videolaryngoscopy in predicted difficult intubations. Eur J Anaesthesiol 2021; 38:201-202. [PMID: 33394801 DOI: 10.1097/eja.0000000000001255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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