Abstract
BACKGROUND AND OBJECTIVES: Preoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid-related parameters assessed preoperatively by surgeons via ultrasonography and chest X-ray on intubation conditions. METHODS: Fifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X-ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale. Statistical analyses were done with SPSS 15.0 software. RESULTS: The mean thyroid volume of the patients was 26.38 ± 14 mL. The median intubation difficulty scale was 1 (0-2). Thyromental distance (p = 0.011; r = 0.36; 95% CI 0.582-0.088), Mallampati score (p = 0.041; r = 0.29; 95% CI 0.013-0.526), compression or invasion signs (p = 0.041; r = 0.28; 95% CI 0.006-0.521) and tracheal deviation on chest X-ray (p = 0.041; r = 0.52; 95% CI 0.268-0.702) were correlated with intubation difficulty scale. Also patients were classified into two groups related to their intubation difficulty scale (Group I, n = 19: intubation difficulty scale = 0; Group II, n = 31: 1 < intubation difficulty scale ≤ 5) and difficult intubation predictors and thyroid-related parameters were compared. Only Mallampati score was significantly different between groups (p = 0.025). CONCLUSION: The thyroid volume is not associated with difficult intubation. However clinical assessment parameters may predict difficult intubation.
Keywords
Ultrasonography, Airway management, Thyroid gland
Resumo
JUSTIFICATIVA E OBJETIVOS: A avaliação ultrassonográfica pré-operatória da glândula tireóide feita por cirurgiões pode prever desafios no manejo das vias aéreas. O objetivo deste estudo observacional foi avaliar os efeitos de parâmetros relacionados à tireóide investigados pré-operatoriamente por cirurgiões mediante ultrassonografia e radiografia de tórax em condições de intubação. MÉTODOS: Foram inscritos 50 pacientes submetidos à cirurgia de tireóide. Distância tireomentoniana (DTM), escore de Mallampati, circunferência do pescoço e amplitude de movimento do pescoço foram avaliados antes da operação. Volume da tireóide, sinais de invasão ou compressão e desvio da traqueia na radiografia de tórax também foram registrados. As condições de intubação foram avaliadas com o escore de Cormack e Lehane (CL) e a escala de intubação difícil (EID). Análises estatísticas foram feitas com o software SPSS 15.0. RESULTADOS: A média do volume da tireóide dos pacientes foi de 26,38 ± 14 mL. A mediana da EID foi de 1 (0-2). DTM (p = 0,011; r = 0,36, IC 95% 0,582-0,088); escore de Mallampati (p = 0,041; r = 0,29, IC 95% 013-0,526); sinais de compressão ou invasão (p = 0,041; r = 0,28; IC 95% 0,006-0,521) e desvio da traqueia na radiografia de tórax (p = 0,041; r = 0,52, IC 95% 0,268-0,702) foram correlacionados com a EID. Os pacientes foram classificados em dois grupos também relacionados à EID (Grupo I, n = 19: EID = 0; Grupo II, n = 31: 1 < EID ≤ 5) e os preditivos de intubação difícil e os parâmetros da tireóide relacionados foram comparados. Apenas o escore de Mallampati foi significativamente diferente entre os grupos (p = 0,025). CONCLUSÃO: O volume da tireóide não está associado à intubação difícil. Contudo, os parâmetros de avaliação clínica podem prever intubação difícil.
Palavras-chave
Ultrassonografia, Manejo das vias aéreas, Glândula tireóide
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