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01.04.2020 | Original Article | Ausgabe 2/2020

Journal of Anesthesia 2/2020

Accuracy of thyromental height test for predicting difficult intubation in elderly

Zeitschrift:
Journal of Anesthesia > Ausgabe 2/2020
Autoren:
Maha Mostafa, Mai Saeed, Ahmed Hasanin, Sahar Badawy, Dalia Khaled
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00540-019-02721-6) contains supplementary material, which is available to authorized users.
A comment to this article is available online at https://​doi.​org/​10.​1007/​s00540-020-02771-1.

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Abstract

Background

Studies of the accuracy of different airway tests are lacking in elderly. We evaluated and compared the accuracy of thyromental height in predicting difficult intubation in relation to the other traditional airway tests in elderly.

Methods

We included 120 patients aged ≥ 65 years scheduled for general anesthesia with tracheal intubation. Thyromental height, modified Mallampati test, thyromental distance and sternomental distance were evaluated. Cormack–Lehane grade > 2 was considered difficult laryngoscopy. Difficult tracheal intubation was considered if successful intubation required more than 2 attempts. The accuracy of different tests in predicting difficult intubation and difficult laryngoscopy were evaluated through area under receiver operating characteristic (AUROC) curves. Univariate and multivariate analyses were conducted to identify risk factors for difficult intubation and difficult laryngoscopy.

Results

Our cohort had a mean age of 71(7) years. We encountered difficult laryngoscopy in 15/120 (12%) patients, difficult intubation in 20/120 (17%) patients, and failed laryngoscopy requiring alternative methods for securing the airway in 3/120 (3%) patients. For predicting difficult intubation, thyromental height and modified Mallampati test showed the highest accuracy AUROC (95% confidence interval): 0.9 (0.83–0.95), cut-off value ≤ 5.9 cm, and AUROC (95% confidence interval): 0.89 (0.82–0.94), cut-off value > 2, respectively. Low thyromental height and high modified Mallampati test were the only independent risk factors for difficult laryngoscopy and difficult intubation.

Conclusion

In elderly scheduled for elective procedure, both thyromental height and modified Mallampati tests showed good accuracy in predicting difficult intubation and difficult laryngoscopy, whilst thyromental distance and sternomental distance were poor predictors.

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