Difficult laryngoscopy and tracheal intubation: observational study

Rebeca Gonelli Albanez da Cunha Andrade; Bruno Luís Soares Lima; Douglas Kaíque de Oliveira Lopes; Roberto Oliveira Couceiro Filho; Luciana Cavalcanti Lima; Tania Cursino de Menezes Couceiro

doi:10.1016/j.bjane.2017.10.010

Scientific Article

Difficult laryngoscopy and tracheal intubation: observational study

Dificuldade na laringoscopia e na intubação orotraqueal: estudo observacional

Rebeca Gonelli Albanez da Cunha Andrade; Bruno Luís Soares Lima; Douglas Kaíque de Oliveira Lopes; Roberto Oliveira Couceiro Filho; Luciana Cavalcanti Lima; Tania Cursino de Menezes Couceiro

http://dx.doi.org/10.1016/j.bjane.2017.10.010 Braz J Anesthesiol, vol.68, n2, p.168-173, 2018

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Abstract

Abstract Introduction: Since anesthesia complications associated with unexpected difficult airway are potentially catastrophic, they should be avoided. The modified Mallampati test and jaw-thrust maneuver enable the identification of difficult airway. The aim of this study was to associate the modified Mallampati test and the jaw-thrust maneuver with laryngoscopy (Cormack–Lehane) in an attempt to identify a better predictor of difficult airway in an adult population undergoing elective surgery. Method: A cross-sectional study in which 133 adult patients undergoing elective surgery requiring tracheal intubation were analyzed. The accuracy and specificity of the modified Mallampati test and jaw-thrust maneuver were assessed by correlating them with difficult laryngoscopy (Cormack–Lehane Degrees 3 and 4). Results: In the 133 patients evaluated the difficult intubation rate found was 0.8%; there was association between the two predictive tests proposed (p = 0.012). The values of 94.5% for specificity and 95.4% for accuracy were found for the jaw-thrust maneuver and for the modified Mallampati test, the values found were 81.1% and 81.2%, respectively. Kappa agreement identified a result of 0.240 between jaw-thrust maneuver and Cormack–Lehane, which was considered reasonable. On the other hand, a poor agreement (κ = 0.06) was seen between modified Mallampati test and Cormack–Lehane test. Conclusion: The jaw-thrust maneuver presented superior accuracy and agreement than the modified Mallampati test, showing the ability to identify a difficult airway. It is necessary to emphasize the association of tests in the evaluation of patients, emphasizing their complementarity to minimize the negative consequences of repeated laryngoscopies.

Keywords

Difficult airway, Airway, Intubation, Laryngoscopy, Mallampati test, Jaw-thrust maneuver

Resumo

Resumo Introdução: As complicações anestésicas associadas às vias aéreas difíceis inesperadas por serem potencialmente catastróficas devem ser evitadas. O teste de Mallampati modificado e a manobra de protrusão mandibular possibilitam a identificação da via aérea difícil. O objetivo deste estudo foi associar o teste de Mallampati modificado e a manobra de protrusão mandibular com a laringoscopia (Cormack-Lehane) e tentar identificar um melhor preditor de via aérea difícil na população adulta submetida à cirurgia eletiva. Método: Estudo corte transversal, foram analisados 133 pacientes adultos submetidos a cirurgias eletivas que necessitavam de intubação orotraqueal. Avaliaram-se a acurácia e especificidade do teste de Mallampati modificado e da manobra de protrusão mandibular, correlacionados com laringoscopia difícil (Cormack-Lehane Graus 3 e 4). Resultados: Entre os 133 pacientes avaliados, a taxa de intubação difícil encontrada foi 0,8%, houve associação entre os dois testes preditores propostos (p = 0,012). Foram encontrados os seguintes valores para a especificidade 94,5% e a acurácia 95,4% na manobra de protrusão mandibular. Já para o teste de Mallampati modificado valores de 81,1% e de 81,2% respectivamente. A análise de concordância Kappa identificou entre manobra de protrusão mandibular e Cormarck-Lehane um resultado de 0,240; considerado razoável. Por outro lado, observou-se uma fraca (κ = 0,06) concordância entre o teste de Mallampati modificado e o Cormarck-Lehane. Conclusão: A manobra de protrusão mandibular apresentou acurácia e concordância superiores ao teste de Mallampati modificado, mostrou a capacidade de identificar uma via aérea difícil. Faz-se necessário enfatizar a associação dos testes na avaliação do paciente, destacar a complementariedade deles, minimizar as consequências negativas de laringoscopias repetidas.

Palavras-chave

Via aérea difícil, Via aérea, Intubação, Laringoscopia, Teste Mallampati, Manobra de protrusão da mandíbula

References

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Difficult laryngoscopy and tracheal intubation: observational study

Dificuldade na laringoscopia e na intubação orotraqueal: estudo observacional

Rebeca Gonelli Albanez da Cunha Andrade; Bruno Luís Soares Lima; Douglas Kaíque de Oliveira Lopes; Roberto Oliveira Couceiro Filho; Luciana Cavalcanti Lima; Tania Cursino de Menezes Couceiro

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