TY - JOUR
T1 - Standard clinical risk factors for difficult laryngoscopy are not independent predictors of intubation success with the GlideScope
AU - Díaz-Gómez, José L.
AU - Satyapriya, Anand
AU - Satyapriya, Sree V.
AU - Mascha, Edward J.
AU - Yang, Dongsheng
AU - Krakovitz, Paul
AU - Mossad, Emad B.
AU - Eikermann, Matthias
AU - Doyle, D. John
PY - 2011/12
Y1 - 2011/12
N2 - Study Objectives: To determine whether the first-attempt tracheal intubation incidence using the GlideScope videolaryngoscope is higher in patients with predicted increased risk of difficult laryngoscopy, and to assess the ability of other a priori defined standard risk factors to predict first-attempt intubation success, in aggregate and by forming scores. Design: Prospective study. Setting: Operating room in a tertiary-care academic center. Patients: 357 patients intubated with the GlideScope for nonemergent general anesthesia. Interventions and Measurements: Mallampati airway class was used to create two groups of patients, one with higher and the other, lower, potential difficult laryngoscopy (Mallampati classes 3-4 and 1-2, respectively). Intubation success on the first attempt with the GlideScope videolaryngoscope in patients with a Mallampati class 3 or 4 airway versus those with Mallampati class 1 or 2 airway was tested. We also evaluated the predictive ability of the Mallampati airway class (1 and 2 vs 3 and 4) along with 9 other possible predictors of difficult intubation on first-attempt intubation success: gender, age, body mass index, level of training within our anesthesia residency program (Clinical Anesthesia Resident years 1, 2, and 3), ASA physical status, mouth opening, thyromental distance, neck flexion, and neck extension. Main Results: None of the standard predictors of difficult intubation was significantly associated with outcome after adjusting for other predictors. A multivariable model containing the aggregate set of variables predicted outcome significantly better than a risk score formed as the sum of 10 predictors ("Risk 10"; P = 0.0176). Conclusions: With GlideScope-assisted tracheal intubation, Mallampati airway class is not an independent risk factor for difficult intubation. Other standard clinical risk factors of difficulty with direct laryngoscopy also do not appear to be individually predictive of first-attempt success of tracheal intubation.
AB - Study Objectives: To determine whether the first-attempt tracheal intubation incidence using the GlideScope videolaryngoscope is higher in patients with predicted increased risk of difficult laryngoscopy, and to assess the ability of other a priori defined standard risk factors to predict first-attempt intubation success, in aggregate and by forming scores. Design: Prospective study. Setting: Operating room in a tertiary-care academic center. Patients: 357 patients intubated with the GlideScope for nonemergent general anesthesia. Interventions and Measurements: Mallampati airway class was used to create two groups of patients, one with higher and the other, lower, potential difficult laryngoscopy (Mallampati classes 3-4 and 1-2, respectively). Intubation success on the first attempt with the GlideScope videolaryngoscope in patients with a Mallampati class 3 or 4 airway versus those with Mallampati class 1 or 2 airway was tested. We also evaluated the predictive ability of the Mallampati airway class (1 and 2 vs 3 and 4) along with 9 other possible predictors of difficult intubation on first-attempt intubation success: gender, age, body mass index, level of training within our anesthesia residency program (Clinical Anesthesia Resident years 1, 2, and 3), ASA physical status, mouth opening, thyromental distance, neck flexion, and neck extension. Main Results: None of the standard predictors of difficult intubation was significantly associated with outcome after adjusting for other predictors. A multivariable model containing the aggregate set of variables predicted outcome significantly better than a risk score formed as the sum of 10 predictors ("Risk 10"; P = 0.0176). Conclusions: With GlideScope-assisted tracheal intubation, Mallampati airway class is not an independent risk factor for difficult intubation. Other standard clinical risk factors of difficulty with direct laryngoscopy also do not appear to be individually predictive of first-attempt success of tracheal intubation.
KW - Airway management
KW - Difficult intubation
KW - GlideScope
KW - Mallampati airway class
KW - Morbid obesity
KW - Preoperative anesthesia assessment
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U2 - 10.1016/j.jclinane.2011.03.006
DO - 10.1016/j.jclinane.2011.03.006
M3 - Article
C2 - 22137510
AN - SCOPUS:82755164347
SN - 0952-8180
VL - 23
SP - 603
EP - 610
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
IS - 8
ER -