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Kim JH, Cheon BR, Kim H, Hwang SM, Lee JJ, Kwon YS. Influence of Curved Video Laryngoscope Blade Sizes and Patient Heights on Video Laryngoscopic Views: A Randomized Controlled Trial. J Pers Med 2024; 14:209. [PMID: 38392642 PMCID: PMC10889943 DOI: 10.3390/jpm14020209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed to compare the video laryngoscope views facilitated by curved blades 3 and 4 with an exploration of the relationship between these views and patient height. Conducted as a randomized controlled trial, this study enrolled adults scheduled for surgery under general anesthesia. Intubation procedures were recorded, and the percentage of glottic opening was measured before tube insertion. Multivariate analysis validated the impact of various factors, including blade size and patient height, on the percentage of glottic opening scores. A total of 192 patients were included. The median percentage of glottic opening scores for curved blades 3 and 4 were 100 and 83, respectively (p < 0.001). The unstandardized coefficient indicated a significant negative impact of blade 4 on the percentage of glottic opening scores (-13, p < 0.001). In the locally estimated scatterplot smoothing analysis, blade 3 exhibited a steady rise in glottic opening scores with increasing height, whereas blade 4 showed a peak followed by a decline around 185 cm. The unstandardized coefficient of height showed no significant association (0, p = 0.819). The study observed superior laryngoscopic views with blade 3 compared to blade 4. However, no significant association was found between laryngoscopic views and patient height.
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Affiliation(s)
- Jong-Ho Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
- Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
| | - Bo-Reum Cheon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
| | - Hyesook Kim
- Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
| | - Sung-Mi Hwang
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
| | - Jae-Jun Lee
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
- Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
| | - Young-Suk Kwon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
- Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
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Ababneh O, Bsisu I, El-Share’ AI, Alrabayah M, Qudaisat I, Alghanem S, Khreesha L, Ali AM, Rashdan M. Awake Nasal Fiberoptic Intubation in Lateral Position for Severely Obese Patients with Anticipated Difficult Airway: A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:2818. [PMID: 37957962 PMCID: PMC10649994 DOI: 10.3390/healthcare11212818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Obesity is a well-recognized risk factor for difficult intubation. To safely manage and overcome airway challenges in severely obese patients with a suspected difficult airway, awake fiberoptic intubation is recommended. We aimed to investigate the utility of awake nasal fiberoptic intubation in severely obese patients with suspected difficult airway while positioning them in the lateral decubitus position. METHODS This randomized controlled trial compared lateral and supine positions for awake nasal fiberoptic intubation in severely obese patients with an anticipated difficult airway by assessing the success rate, time needed to secure the airway, peri-procedural adverse events, and postoperative satisfaction of patients. RESULTS Sixty patients with a median age of 37 [inter-quartile range (IQR): 29-44] years were included, of which 47 (78.3%) were females. The median body mass index (BMI) was 45.5 [IQR: 42.5-50.8] kg/m2. The success rate of fiberoptic intubation was 100% in both groups. The time needed to successfully secure the airway was 188 [148.8-228.8] seconds (s) in the lateral position, compared to 214.5 [181.8-280.5] s in supine position (p = 0.019). Intraprocedural cough was more common in the supine position group (n = 8; 26.7%), compared to the lateral position group (n = 3; 10%; p = 0.095). Postoperative sore throat was more common in the lateral position group (n = 12; 40%) compared to the supine position (n = 5; 16.7%; p = 0.045). CONCLUSIONS In conclusion, Intubation in the lateral position is a promising technique that is equivalent to the routine supine position during fiberoptic intubation. In fact, intubation in the lateral position took less time to successfully secure the airway.
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Affiliation(s)
- Omar Ababneh
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan; (M.A.); (I.Q.); (S.A.)
| | - Isam Bsisu
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan; (M.A.); (I.Q.); (S.A.)
- UCSF Center for Health Equity in Surgery and Anesthesia, San Francisco, CA 94158, USA
| | - Ahmad I. El-Share’
- Department of Anesthesia and Pain Management, King Hussein Cancer Center, Amman 11941, Jordan;
| | - Mustafa Alrabayah
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan; (M.A.); (I.Q.); (S.A.)
| | - Ibraheem Qudaisat
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan; (M.A.); (I.Q.); (S.A.)
| | - Subhi Alghanem
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman 11942, Jordan; (M.A.); (I.Q.); (S.A.)
| | - Lubna Khreesha
- Department of Special Surgeries, School of Medicine, The University of Jordan, Amman 11942, Jordan;
| | - Amani Mohamed Ali
- Department of Undergraduate Studies, School of Medicine, The University of Jordan, Amman 11942, Jordan;
| | - Mohammad Rashdan
- Department of General Surgery, School of Medicine, The University of Jordan, Amman 11942, Jordan;
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Bala R, Budhwar D, Kumar V, Singhal S, Kaushik P, Sharma J. Clinical and ultrasonographic assessment of airway indices among non-pregnant, normotensive pregnant and pre-eclamptic patients: a prospective observational study. Int J Obstet Anesth 2023; 54:103637. [PMID: 36827944 DOI: 10.1016/j.ijoa.2023.103637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prediction of a difficult airway is of paramount importance for an anaesthesiologist. Various anatomical and physiological factors contribute to a difficult airway in pregnant females, especially those with pre-eclampsia. The aim of the study was to assess airway indices using both routinely used clinical methods and ultrasound. METHODS Fifty-five non-pregnant females, 55 normotensive pregnant females and 55 females with pre-eclampsia were included in this prospective study. Clinical airway assessment was the modified Mallampati score, thyromental distance, hyomental distance, hyomental distance ratio, chest circumference, neck circumference and chest-to-neck circumference ratio. Sonographic assessment included tongue width, tongue volume, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, subglottic diameter, ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds. RESULTS Several significant differences were observed between pregnant and non-pregnant females, with additional changes in pre-eclamptic females. These included clinical parameters such as the modified Mallampati score and sonographic measurements of tongue width, tongue volume, subglottic diameter, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, and the ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds. CONCLUSION Routinely used clinical methods of airway assessment lack sensitivity and specificity. Ultrasound can visualise anatomical structures in the supraglottic and subglottic views and is encouraging as an airway assessment tool.
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Affiliation(s)
- R Bala
- Department of Anesthesia, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - D Budhwar
- Department of Anesthesia, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - V Kumar
- Department of Anesthesia, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India.
| | - S Singhal
- Department of Obstetrics and Gynaecology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - P Kaushik
- Department of Radiology, PT. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - J Sharma
- Department of Anesthesia, AIIMS Bhatinda, Punjab 151001, India
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Zhou CM, Wang Y, Xue Q, Yang JJ, Zhu Y. Predicting difficult airway intubation in thyroid surgery using multiple machine learning and deep learning algorithms. Front Public Health 2022; 10:937471. [PMID: 36033770 PMCID: PMC9399522 DOI: 10.3389/fpubh.2022.937471] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/12/2022] [Indexed: 01/25/2023] Open
Abstract
Background In this paper, we examine whether machine learning and deep learning can be used to predict difficult airway intubation in patients undergoing thyroid surgery. Methods We used 10 machine learning and deep learning algorithms to establish a corresponding model through a training group, and then verify the results in a test group. We used R for the statistical analysis and constructed the machine learning prediction model in Python. Results The top 5 weighting factors for difficult airways identified by the average algorithm in machine learning were age, sex, weight, height, and BMI. In the training group, the AUC values and accuracy and the Gradient Boosting precision were 0.932, 0.929, and 100%, respectively. As for the modeled effects of predicting difficult airways in test groups, among the models constructed by the 10 algorithms, the three algorithms with the highest AUC values were Gradient Boosting, CNN, and LGBM, with values of 0.848, 0.836, and 0.812, respectively; In addition, among the algorithms, Gradient Boosting had the highest accuracy with a value of 0.913; Additionally, among the algorithms, the Gradient Boosting algorithm had the highest precision with a value of 100%. Conclusion According to our results, Gradient Boosting performed best overall, with an AUC >0.8, an accuracy >90%, and a precision of 100%. Besides, the top 5 weighting factors identified by the average algorithm in machine learning for difficult airways were age, sex, weight, height, and BMI.
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Affiliation(s)
- Cheng-Mao Zhou
- Department of Anaesthesiology, Central People's Hospital of Zhanjiang, Zhanjiang, China,Department of Anesthesiology, Pain and Perioperative Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Anesthesia and Big Data Research Group, Central People's Hospital of Zhanjiang, Zhanjiang, China,*Correspondence: Cheng-Mao Zhou
| | - Ying Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiong Xue
- Department of Anesthesiology, Pain and Perioperative Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian-Jun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Jian-Jun Yang
| | - Yu Zhu
- Department of Anaesthesiology, Central People's Hospital of Zhanjiang, Zhanjiang, China,Anesthesia and Big Data Research Group, Central People's Hospital of Zhanjiang, Zhanjiang, China,Yu Zhu
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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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Öterkuş M, Dönmez İ, Nadir AH, Rencüzoğulları İ, Karabağ Y, Binnetoğlu K. The effect of low flow anesthesia on hemodynamic and peripheral oxygenation parameters in obesity surgery. Saudi Med J 2021; 42:264-269. [PMID: 33632904 PMCID: PMC7989260 DOI: 10.15537/smj.2021.42.3.20200575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/24/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: To investigate the effects of low-flow anesthesia on hemodynamic parameters and recovery from anesthesia in obese individuals undergoing laparoscopic surgery. Methods: This randomized-controlled and prospective study included 44 obese patients who underwent laparoscopic sleeve gastrectomy operation. The patients were randomly allocated into 2 groups as low-flow and high-flow anesthesia. Further, the groups compared in terms of hemodynamic parameters, anesthesia recovery times, operation times, and arterial blood gas parameters. Results: The groups were similar with respect to demographic data. Heart rate, peripheral oxygen saturation, arterial blood pressure measurements, end-tidal, and CO2, lactate levels measurements were similar in both groups during the entire procedure. There was also no statistically significant difference in terms of arterial blood gas parameters or anesthesia recovery periods. Conclusion: Low-flow anesthesia in laparoscopic obesity surgery seems to be safer compared to high-flow anesthesia in terms of the adequacy of tissue perfusion, depth of anesthesia, and postoperative recovery.
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Affiliation(s)
- Mesut Öterkuş
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
- Address correspondence and reprint request to: Dr. Mesut Öterkuş, Assistant Professor, Department of Anesthesiology and Reanimation, Faculty of Medicine, Malatya Turgut Özal University, Malatya, Turkey. E-mail: ORCID ID: http://orcid.org/0000-0003-1025-7662
| | - İlksen Dönmez
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - Aysu H. Nadir
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - İbrahim Rencüzoğulları
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - Yavuz Karabağ
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - Kenan Binnetoğlu
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
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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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Constructing a prediction model for difficult intubation of obese patients based on machine learning. J Clin Anesth 2021; 72:110278. [PMID: 33857844 DOI: 10.1016/j.jclinane.2021.110278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 11/21/2022]
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Mushambi MC, Athanassoglou V, Kinsella SM. Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations. Anaesthesia 2020; 75:945-961. [DOI: 10.1111/anae.15007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 12/16/2022]
Affiliation(s)
- M. C. Mushambi
- Department of Anaesthesia University Hospitals of Leicester LeicesterUK
| | - V. Athanassoglou
- Nuffield Department of Anaesthetics Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - S. M. Kinsella
- Department of Anaesthesia St Michael's Hospital Bristol UK
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Riad W. Faultless impressive results: How can I do it? Saudi J Anaesth 2019; 13:S23-S26. [PMID: 30930715 PMCID: PMC6398297 DOI: 10.4103/sja.sja_690_18] [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] [Indexed: 12/01/2022] Open
Abstract
The result section of the research presents your actual work. The results could be either support or invalidate the research hypothesis. Writing in a scientific, impressive and faultless way increases the chance of acceptance in high impact factors journal. The result would be in a descriptive style around 3-4 paragraphs. The first paragraph is normally an illustration of the studied population. Followed by the second paragraph, which is a description of the main results. Expressing the secondary outcome is usually the next paragraph. Additional results not directly related to the research question are mentioned in the last paragraph. Chosen the correct format for the data (Tables and Figures) is mentioned in this review.
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Affiliation(s)
- Waleed Riad
- Department of Anesthesia, Corniche Hospital, Abu Dhabi, United Arab Emirates
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Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits AM, Arrich J, Herkner H. Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review. Anaesthesia 2019; 74:915-928. [DOI: 10.1111/anae.14608] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 12/13/2022]
Affiliation(s)
- D. Roth
- Emergency Medicine Medical University of Vienna Austria
| | - N. L. Pace
- Department of Anesthesiology University of Utah Salt Lake City UT USA
| | - A. Lee
- Department of Anaesthesia and Intensive Care The Chinese University of Hong Kong Shatin Hong Kong
- Hong Kong Branch of The Chinese Cochrane Centre The Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - K. Hovhannisyan
- Clinical Health Promotion Centre Faculty of Medicine Lund University MalmöSweden
| | - A. M. Warenits
- Department of Emergency Medicine Medical University of Vienna Austria
| | - J. Arrich
- Department of Emergency Medicine Medical University of Vienna Austria
| | - H. Herkner
- Department of Emergency Medicine Medical University of Vienna Austria
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12
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Jarraya A, Choura D, Mejdoub Y, Kammoun M, Grati F, Kolsi K. New predictors of difficult intubation in obstetric patients: A prospective observational study. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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13
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Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits A, Arrich J, Herkner H. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst Rev 2018; 5:CD008874. [PMID: 29761867 PMCID: PMC6404686 DOI: 10.1002/14651858.cd008874.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The unanticipated difficult airway is a potentially life-threatening event during anaesthesia or acute conditions. An unsuccessfully managed upper airway is associated with serious morbidity and mortality. Several bedside screening tests are used in clinical practice to identify those at high risk of difficult airway. Their accuracy and benefit however, remains unclear. OBJECTIVES The objective of this review was to characterize and compare the diagnostic accuracy of the Mallampati classification and other commonly used airway examination tests for assessing the physical status of the airway in adult patients with no apparent anatomical airway abnormalities. We performed this individually for each of the four descriptors of the difficult airway: difficult face mask ventilation, difficult laryngoscopy, difficult tracheal intubation, and failed intubation. SEARCH METHODS We searched major electronic databases including CENTRAL, MEDLINE, Embase, ISI Web of Science, CINAHL, as well as regional, subject specific, and dissertation and theses databases from inception to 16 December 2016, without language restrictions. In addition, we searched the Science Citation Index and checked the references of all the relevant studies. We also handsearched selected journals, conference proceedings, and relevant guidelines. We updated this search in March 2018, but we have not yet incorporated these results. SELECTION CRITERIA We considered full-text diagnostic test accuracy studies of any individual index test, or a combination of tests, against a reference standard. Participants were adults without obvious airway abnormalities, who were having laryngoscopy performed with a standard laryngoscope and the trachea intubated with a standard tracheal tube. Index tests included the Mallampati test, modified Mallampati test, Wilson risk score, thyromental distance, sternomental distance, mouth opening test, upper lip bite test, or any combination of these. The target condition was difficult airway, with one of the following reference standards: difficult face mask ventilation, difficult laryngoscopy, difficult tracheal intubation, and failed intubation. DATA COLLECTION AND ANALYSIS We performed screening and selection of the studies, data extraction and assessment of methodological quality (using QUADAS-2) independently and in duplicate. We designed a Microsoft Access database for data collection and used Review Manager 5 and R for data analysis. For each index test and each reference standard, we assessed sensitivity and specificity. We produced forest plots and summary receiver operating characteristic (ROC) plots to summarize the data. Where possible, we performed meta-analyses to calculate pooled estimates and compare test accuracy indirectly using bivariate models. We investigated heterogeneity and performed sensitivity analyses. MAIN RESULTS We included 133 (127 cohort type and 6 case-control) studies involving 844,206 participants. We evaluated a total of seven different prespecified index tests in the 133 studies, as well as 69 non-prespecified, and 32 combinations. For the prespecified index tests, we found six studies for the Mallampati test, 105 for the modified Mallampati test, six for the Wilson risk score, 52 for thyromental distance, 18 for sternomental distance, 34 for the mouth opening test, and 30 for the upper lip bite test. Difficult face mask ventilation was the reference standard in seven studies, difficult laryngoscopy in 92 studies, difficult tracheal intubation in 50 studies, and failed intubation in two studies. Across all studies, we judged the risk of bias to be variable for the different domains; we mostly observed low risk of bias for patient selection, flow and timing, and unclear risk of bias for reference standard and index test. Applicability concerns were generally low for all domains. For difficult laryngoscopy, the summary sensitivity ranged from 0.22 (95% confidence interval (CI) 0.13 to 0.33; mouth opening test) to 0.67 (95% CI 0.45 to 0.83; upper lip bite test) and the summary specificity ranged from 0.80 (95% CI 0.74 to 0.85; modified Mallampati test) to 0.95 (95% CI 0.88 to 0.98; Wilson risk score). The upper lip bite test for diagnosing difficult laryngoscopy provided the highest sensitivity compared to the other tests (P < 0.001). For difficult tracheal intubation, summary sensitivity ranged from 0.24 (95% CI 0.12 to 0.43; thyromental distance) to 0.51 (95% CI 0.40 to 0.61; modified Mallampati test) and the summary specificity ranged from 0.87 (95% CI 0.82 to 0.91; modified Mallampati test) to 0.93 (0.87 to 0.96; mouth opening test). The modified Mallampati test had the highest sensitivity for diagnosing difficult tracheal intubation compared to the other tests (P < 0.001). For difficult face mask ventilation, we could only estimate summary sensitivity (0.17, 95% CI 0.06 to 0.39) and specificity (0.90, 95% CI 0.81 to 0.95) for the modified Mallampati test. AUTHORS' CONCLUSIONS Bedside airway examination tests, for assessing the physical status of the airway in adults with no apparent anatomical airway abnormalities, are designed as screening tests. Screening tests are expected to have high sensitivities. We found that all investigated index tests had relatively low sensitivities with high variability. In contrast, specificities were consistently and markedly higher than sensitivities across all tests. The standard bedside airway examination tests should be interpreted with caution, as they do not appear to be good screening tests. Among the tests we examined, the upper lip bite test showed the most favourable diagnostic test accuracy properties. Given the paucity of available data, future research is needed to develop tests with high sensitivities to make them useful, and to consider their use for screening difficult face mask ventilation and failed intubation. The 27 studies in 'Studies awaiting classification' may alter the conclusions of the review, once we have assessed them.
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Affiliation(s)
- Dominik Roth
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20ViennaAustriaA‐1090
| | - Nathan L Pace
- University of UtahDepartment of Anesthesiology3C444 SOM30 North 1900 EastSalt Lake CityUTUSA84132‐2304
| | - Anna Lee
- The Chinese University of Hong KongDepartment of Anaesthesia and Intensive CarePrince of Wales HospitalShatinNew TerritoriesHong Kong
- The Chinese University of Hong KongHong Kong Branch of The Chinese Cochrane Centre, The Jockey Club School of Public Health and Primary Care, Faculty of MedicineShatinNew TerritoriesHong Kong
| | - Karen Hovhannisyan
- Lund UniversityClinical Health Promotion Centre, Faculty of MedicineSkånes Universitetssjukhus, Södra Förstadsgatan 35, Plan 4MalmöSwedenS‐205 02
| | - Alexandra‐Maria Warenits
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20ViennaAustriaA‐1090
| | - Jasmin Arrich
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20ViennaAustriaA‐1090
| | - Harald Herkner
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20ViennaAustriaA‐1090
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