Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2022.04.004
Brazilian Journal of Anesthesiology
Original Investigation

Upper airway angle and glottic height: a prospective cohort to evaluate two new features for airway prediction

Ângulo das vias aéreas superiores e altura glótica: uma coorte prospectiva para avaliar dois novos recursos para predição das vias aéreas

Clístenes Crístian de Carvalho, Danielle Melo da Silva, Marina Sampaio Leite, Lívia Barboza de Andrade

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Abstract

Background
Predicting difficult direct laryngoscopies remains challenging and improvements are needed in preoperative airway assessment. We conceived two new tests (the upper airway angle and the glottic height) and assessed their association with difficult direct laryngoscopies as well as their predictive performance.

Methods
A prospective cohort was conducted with 211 patients undergoing general anesthesia for surgical procedures. We assessed the association between difficult laryngoscopies and modified Mallampati Test (MMT), Upper Lip Bite Test (ULBT), Mandibular Length (ML), Neck Circumference (NC), Mouth Opening (MO), Sternomental Distance (SMD), Thyromental Distance (TMD), Upper Airway Angle (UAA), and Glottic Height (GH). We also estimated their predictive values.

Results
Difficult laryngoscopy was presented by 12 patients (5.7%). Six tests were significantly associated with difficult laryngoscopies and their area under the ROC curve, and 95% CIs were as follows: UAA = 88.82 (81.86–95.78); GH = 86.43 (72.67–100); ML = 83.75 (72.77–94.74); NC = 79.17 (64.98–93.36); MO = 65.58 (45.13–86.02); and MMT = 77.89 (68.37–87.41).

Conclusion
We have found two new features (the UAA and the GH) to be significantly associated with the occurrence of difficult direct laryngoscopies. They also presented the best predictive performance amongst the nine evaluated tests in our cohort of patients. We cannot ensure, however, these tests to be superior to other regularly used bedside tests based on our estimated 95% CIs.

Keywords

Airway management;  Laryngoscopy;  Predictive values of tests;  Sensitivity and specificity

Resumo

Introdução

A previsão de laringoscopias diretas difíceis continua sendo um desafio e melhorias são necessárias na avaliação pré-operatória das vias aéreas. Concebemos dois novos testes (o ângulo da via aérea superior e a altura glótica) e avaliamos sua associação com laringoscopias diretas difíceis, bem como seu desempenho preditivo.

Métodos

Uma coorte prospectiva foi realizada com 211 pacientes submetidos à anestesia geral para procedimentos cirúrgicos. Avaliamos a associação entre laringoscopias difíceis e teste de Mallampati modificado (MMT), teste de mordida do lábio superior (ULBT), comprimento mandibular (ML), circunferência do pescoço (NC), abertura da boca (MO), distância esternomental (SMD), distância tireomentoniana (DTM), Ângulo das Vias Aéreas Superiores (UAA) e Altura Glótica (GH). Também estimamos seus valores preditivos.

Resultados

A laringoscopia difícil foi apresentada por 12 pacientes (5,7%). Seis testes foram significativamente associados a laringoscopias difíceis e sua área sob a curva ROC, e os ICs de 95% foram os seguintes: UAA = 88,82 (81,86–95,78); GH = 86,43 (72,67–100); ML = 83,75 (72,77–94,74); NC = 79,17 (64,98–93,36); MO = 65,58 (45,13–86,02); e MMT = 77,89 (68,37–87,41).

Conclusão

Encontramos dois novos itens (UAA e GH) significativamente associados à ocorrência de laringoscopias diretas difíceis. Eles também apresentaram o melhor desempenho preditivo entre os nove testes avaliados em nossa coorte de pacientes. Não podemos garantir, no entanto, que esses testes sejam superiores a outros testes de beira de leito usados regularmente com base em nossos ICs estimados de 95%.

Palavras-chave

Manejo de vias aéreas; Laringoscopia; Valores preditivos de testes; Sensibilidade e especificidade

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