Dataset Information

Evaluation of thyromental height test in prediction of difficult airway in obese surgical patients: An observational study.

ABSTRACT:

Background and aims

Thyromental height test (TMHT) has revealed good potentials for predicting difficult laryngoscopy view (DLV) in non-obese patients, but its accuracy in obese patients is not evident. This study aimed to assess the validity of TMHT as a predictor of DLV in obese surgical patients.

Methods

105 patients, aged 18-60 years, with body mass index (BMI) >30 kg/m², scheduled for elective surgeries under general anaesthesia with an endotracheal tube inserted using conventional laryngoscope were included. Airway was assessed with TMHT, modified Mallampati test (MMT), neck circumference (NC) and NC/TMHT ratio. The DLV was defined as Cormack-Lehane grade ≥3. The primary endpoint was the validity of TMHT as a predictor of DLV. The secondary endpoints were to compare the accuracy of TMHT with that of the NC, MMT and NC/TMHT ratio as predictors of the difficult airway.

Results

The BMI was 43.7 ± 6.6 kg/m². The DLV cases were 23/105 (21.9%). The MMT, TMHT and NC/TMHT ratio had the best predictive ability of DLV with areas under receiver operating characteristic curve of 0.91, 0.92 and 0.80; at cut-off values >2, <47 mm and >7.9, respectively. MMT and TMHT were the only predictors of DLV by multivariate analysis.

Conclusion

In obese surgical patients, TMHT is an excellent predictor of DLV when the cut-off value is <47 mm.

SUBMITTER: Ahmed AM

PROVIDER: S-EPMC8820326 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Publications

Evaluation of thyromental height test in prediction of difficult airway in obese surgical patients: An observational study.

Ahmed Abeer M AM Zaky Monica N MN El-Mekawy Nevan M NM Ollaek Mohamed A MA Sami Wael M WM Mohamed Dina M DM

Indian journal of anaesthesia 20211222 12

<h4>Background and aims</h4>Thyromental height test (TMHT) has revealed good potentials for predicting difficult laryngoscopy view (DLV) in non-obese patients, but its accuracy in obese patients is not evident. This study aimed to assess the validity of TMHT as a predictor of DLV in obese surgical patients.<h4>Methods</h4>105 patients, aged 18-60 years, with body mass index (BMI) >30 kg/m<sup>2</sup>, scheduled for elective surgeries under general anaesthesia with an endotracheal tube inserted u ...[more]

PMID: 35221360

Similar Datasets

Project description:The thyromental height test (TMHT) has been proposed as a novel single clinical test for predicting difficult laryngoscopy (DL), though consequent studies have put forward various estimates when verifying its reliability. This systematic review and meta-analysis aimed to provide a comprehensive evaluation of the predictive value of TMHT for DL. A computerized search of CNKI, CQVIP, EBSCO, PubMed, SinoMed, and Wanfang Data was conducted on 1 June 2022. Prospective cohort studies reporting diagnostic properties of TMHT in relation to Cormack and Lehane grading in patients aged more than 16 years, either sex, scheduled for surgery under general anesthesia, requiring tracheal intubation with direct laryngoscopy were included in this analysis. Data was extracted or calculated, and meta-analysis was done by the Stata MIDAS module. A total of 23 studies with 5896 patients were included in this analysis. Summary estimates of all included studies are as follows: sensitivity 74% (95% CI, 68-79%); specificity 88% (95% CI, 81-92%); diagnostic odd ratio, 20 (95% CI, 10-40); positive likelihood ratio, 5.9 (95% CI, 3.6-9.6); and negative likelihood ratio, 0.30 (95% CI, 0.23-0.39). Summary sensitivity and specificity for studies with a prespecified threshold were 82% (95% CI, 71-89%) and 94% (95% CI, 87-98%), respectively. The estimated area under curve (AUC) was 85% (95% CI, 81-88%). There was no significant threshold effect but significant heterogeneity in both sensitivity and specificity. Heterogeneity in sensitivity became insignificant after removing two outliers of sensitivity analysis. It is concluded that THMT has an overall optimal predictive value for DL in adult patients with diverse ethnicity and various risk factors, displaying better predictive values in a large patient population comparing to other recent reported bedside assessments and a previous meta-analysis. As significant heterogeneity brought by un-standardized application of external laryngeal manipulations in the included studies may have biased the results of this meta-analysis, the actual predictive value of TMHT for DL still awaits further studies with good designs and large sample sizes for better determination.

Project description:INTRODUCTION:Difficult tracheal intubation (DTI) contributes to perioperative morbidity and mortality. There are conflicting study results about the most predictive DTI risk criteria in patients undergoing thyroid surgery. MATERIALS AND METHODS:We conducted a prospective observational study on 500 consecutive patients aged ≥18 years to identify predictors for DTI. Body weight, body mass index (BMI), inability to prognath, head movement, mouth opening, Mallampati score, neck circumference (NC), thyromental distance (TMD), neck circumference to thyromental distance ratio (NC/TMD), tracheal deviation apparent on chest x-ray, mediastinal goiter, histology and history of DTI were measured as possible predictors of DTI. Spearman's rank correlation test and multiple logistic regression analysis were performed. RESULTS:DTI was observed in 9.6% of all patients. Compared with the group of patients without DTI, the group of patients with DTI had significantly greater median values for body weight, BMI, NC, NC/TMD, Mallampati score, el-Ganzouri score, incidence of mediastinal goiter, and had reduced TMD and mouth opening. Significant correlations between BMI ≥30 kg/m2 and the Mallampati score ≥3 (R = 0.124, p = 0.00541), Cormack-Lehane ≥3 (R = 0.128, p = 0.00409), NC ≥40 cm (R = 0.376, p<0.001), and NC/TMD ≥5 (R = 0.103, p = 0.0207) were found. The logistic regression analysis revealed that an NC ≥40 cm at the goiter level, but not an NC/TMD ratio ≥5, was the strongest predictor of DTI (p<0.001). The area under the receiver operating characteristic curve for NC/TMD was better than the curve for NC. The sensitivity and specificity of NC/TMD were also greater, compared with NC. An NC of 40.00 cm and an NC/TMD of 5.85 were the estimated cut-off points. DISCUSSION:This study found that NC was a strong predictor of DTI. The results also suggested that NC/TMD could be used as a measure to stratify the risk of DTI in patients undergoing thyroid surgery.

Dataset Information

Evaluation of thyromental height test in prediction of difficult airway in obese surgical patients: An observational study.

Background and aims

Methods

Results

Conclusion

Publications

Evaluation of thyromental height test in prediction of difficult airway in obese surgical patients: An observational study.

Similar Datasets

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