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Journal articles on the topic 'Difficult Intubation'

Author: Grafiati

Published: 4 June 2021

Last updated: 20 June 2025

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1

Tsay, Pei-Jiuan, Chih-Pin Yang, Hsiang-Ning Luk, Jason Zhensheng Qu, and Alan Shikani. "Video-Assisted Intubating Stylet Technique for Difficult Intubation: A Case Series Report." Healthcare 10, no. 4 (2022): 741. http://dx.doi.org/10.3390/healthcare10040741.

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Induction of anesthesia can be challenging for patients with difficult airways and head or neck tumors. Factors that could complicate airway management include poor dentition, limited mouth opening, restricted neck motility, narrowing of oral airway space, restricted laryngeal and pharyngeal space, and obstruction of glottic regions from the tumor. Current difficult airway management guidelines include awake tracheal intubation, anesthetized tracheal intubation, or combined awake and anesthetized intubation. Video laryngoscopy is often chosen over direct laryngoscopy in patients with difficult airways because of an improved laryngeal view, higher frequency of successful intubations, higher frequency of first-attempt intubation, and fewer intubation attempts. In this case series report, we describe the video-assisted intubating stylet technique in five patients with difficult airways. We believe that the intubating stylet is a feasible and safe airway technique for anesthetized tracheal intubation in patients with an anticipated difficult airway.

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2

Adnet, Frederic, Stephen W. Borron, Stephane X. Racine, et al. "The Intubation Difficulty Scale (IDS)." Anesthesiology 87, no. 6 (1997): 1290–97. http://dx.doi.org/10.1097/00000542-199712000-00005.

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Background A quantitative scale of intubation difficulty would be useful for objectively comparing the complexity of endotracheal intubations. The authors have developed a quantitative score that can be used to evaluate intubating conditions and techniques with the aim of determining the relative values of predictive factors of intubation difficulty and of the techniques used to decrease such difficulties. Methods An Intubation Difficulty Scale (IDS) was developed, based on parameters known to be associated with difficult intubation. It was then evaluated prospectively in a group of 311 consecutive prehospital intubations and 315 intubations in an operating room. In the operating room, the IDS was compared with two other parameters: the time to completion of intubation and the visual analog scale (VAS). Time was measured by an independent observer. Operators in both groups completed a checklist regarding the conditions of intubation. Results There is a good correlation between the IDS scale and the VAS assessment of difficulty and time to completion of intubation. VAS and time to completion have a significant but lesser correlation to each other. Comparison of IDS with operator-assessed subjective categorical impression of difficulty by Kruskall-Wallis was statistically significant. Conclusions The IDS correlates with but is less subjective than the VAS and categorical classification. IDS correlates with time to intubation, but it offers details regarding the difficulty encountered that time alone does not. This score may not only aid in evaluation of factors linked to difficult intubations, but it may provide a uniform approach to comparing studies related to this subject.

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Artawan, I. Made, Su Djie To Rante, and Sidarta Sagita. "Comparison of the Thyromental Distance, Thyrohyoid Distance, and Mallampati Scores in Prediction of Difficult Intubation in Patients Undergoing General Anaesthesia: An Observational Study." Bali Journal of Anesthesiology 8, no. 3 (2024): 154–57. http://dx.doi.org/10.4103/bjoa.bjoa_116_24.

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Abstract Background: Several studies have been conducted to assess the accuracy of predictors of difficult intubation, but the results are still very variable. This study aims to discover the incidence of difficult intubation in our cohort. We also compared the accuracy of the Mallampati score, thyromental distance, and thyrohyoid distance in predicting intubation difficulties in patients who will undergo surgery under general anesthesia. Materials and Methods: This prospective, observational study was conducted on 100 subjects who met the inclusion and exclusion criteria and had their Mallampati score, thyromental distance, and thyrohyoid distance measured preoperatively. After inducing anesthesia, the degree of difficulty in intubation was assessed using the Cormack-Lehane grading. The Mallampati score, thyromental distance, and thyrohyoid distance were then tested for accuracy as predictors of the occurrence of difficult intubation using the binomial logistic regression. Results: The incidence of difficult intubation was 21%. We found a significant difference (P < 0.001) between the Mallampati score and the degree of intubation difficulty, where subjects with a Mallampati score of 1–2 experienced fewer intubation difficulties. The mean thyromental distance differed significantly between subjects with and without difficulty intubating (6.3 ± 0.6 vs. 4.6 ± 0.6 cm, P < 0.001). There was also a significant difference in the mean thyrohyoid distance between subjects with and without difficulty intubating (3.6 ± 0.4 vs. 2.0 ± 0.2, P < 0.001). Conclusion: Mallampati score, thyromental distance, and thyrohyoid distance were not significant as single predictors of difficult intubation, but they were significant when combined.

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Dr., Maira Mansoor Dr. Rija Khalid Dr. Muhammad Usman Khalid. "POSITIVE PREDICTIVE VALUE OF RESTRICTED NECK MOVEMENT IN ASSESSING DIFFICULT INTUBATION TAKING INTUBATION DIFFICULTY SCALE AS GOLD STANDARD." INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES 05, no. 05 (2018): 4483–92. https://doi.org/10.5281/zenodo.1256353.

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<strong><em>Introduction: </em></strong><em>Airway maintenance during anesthesia is crucial for adequate oxygenation and ventilation and failure to secure airway can lead to tissue hypoxia and ultimately death. The three main causes of respiratory related injuries of anesthesia are inadequate ventilation, esophageal intubation and difficult tracheal intubation. 17% of all respiratory related injuries are due to difficult intubation and it accounts for 28% of anesthesia related deaths'.</em> <strong><em>Subjects and Methods:</em></strong><em> This study involved 126 patients of both genders, aged between I8-70 years undergoing general anesthesia with endotracheal intubation on elective lists Difficult intubation was predicted on restricted neck movement (<80°) and was confirmed on IDS. IDS diagnosis was taken as gold standard and results of restricted neck movement were evaluated accordingly. Written informed consent was taken from every patient.</em> <strong><em>Results:</em></strong><em> The age of the patients ranged from 18 years to 70 years with a mean of 42.49 + 14.56 years. There were 64 (50.8%) male and 62 (49.2%) female patients in the study group. There were 52 (41.3%) obese patients. Difficult intubation was confirmed in 90 (71.4%) patients on intubation difficulty scale (as per operational definition). 1'he frequency of difficult intubation was higher among obese patients (80.8% vs. 64.9%; p 0.052) however the difference was insignificant. There were 90 (71.4%) true positive patients with 36 false positive patients. It yielded a positive predictive value of 71.4% for restricted neck movement in the prediction of difficult intubation taking IDS as gold standard. Similar positive predictive value was observed across age, gender and obesity groups.</em> <strong><em>Conclusion:</em></strong><em> The positive predictive value of restricted neck movement (<80°) was found to be 71.4% in predicting difficult intubation among patients undergoing general anesthesia with endotracheal intubation on elective list while taking intubation difficulty scale as the gold standard.</em> <strong>Keywords:</strong><em> Difficult Intubation. Intubation Difficulty Scale. Restricted Neck Movement</em>.

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5

Dr., Salman Hameed Dr. Jumana Fatima Dr. Abdul Sami. "BY TAKING INTUBATION DIFFICULTY SCALE AS GOLD STANDARD IN ASSESSING DIFFICULT INTUBATION AND PREDICTIVE VALUE OF RESTRICTED NECK MOVEMENT." INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES 05, no. 05 (2018): 4493–98. https://doi.org/10.5281/zenodo.1256355.

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<strong><em>Introduction: </em></strong><em>The three main causes of respiratory related injuries of anesthesia are inadequate ventilation, esophageal intubation and difficult tracheal intubation. 17% of all respiratory related injuries are due to difficult intubation and it accounts for 28% of anesthesia related deaths’. Airway maintenance during anesthesia is crucial for adequate oxygenation and ventilation and failure to secure airway can lead to tissue hypoxia and ultimately death. </em> <strong><em>Subjects and Methods:</em></strong><em> This study involved 126 patients of both genders, aged between I8-70 years undergoing general anesthesia with endotracheal intubation on elective lists Difficult intubation was predicted on restricted neck movement (<80°) and was confirmed on IDS. IDS diagnosis was taken as gold standard and results of restricted neck movement were evaluated accordingly. Written informed consent was taken from every patient.</em> <strong><em>Results:</em></strong><em> The age of the patients ranged from 18 years to 70 years with a mean of 42.49 + 14.56 years. There were 64 (50.8%) male and 62 (49.2%) female patients in the study group. There were 52 (41.3%) obese patients. Difficult intubation was confirmed in 90 (71.4%) patients on intubation difficulty scale (as per operational definition). 1'he frequency of difficult intubation was higher among obese patients (80.8% vs. 64.9%; p 0.052) however the difference was insignificant. There were 90 (71.4%) true positive patients with 36 false positive patients. It yielded a positive predictive value of 71.4% for restricted neck movement in the prediction of difficult intubation taking IDS as gold standard. Similar positive predictive value was observed across age, gender and obesity groups.</em> <strong><em>Conclusion:</em></strong><em> The positive predictive value of restricted neck movement (<80°) was found to be 71.4% in predicting difficult intubation among patients undergoing general anesthesia with endotracheal intubation on elective list while taking intubation difficulty scale as the gold standard.</em> <strong>Keywords:</strong> <em>Difficult Intubation. Intubation Difficulty Scale. Restricted Neck Movement.</em>

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6

Dr., Salman Hameed Dr. Jumana Fatima Dr. Abdul Sami. "BY TAKING INTUBATION DIFFICULTY SCALE AS GOLD STANDARD IN ASSESSING DIFFICULT INTUBATION AND PREDICTIVE VALUE OF RESTRICTED NECK MOVEMENT." Indo American Journal of Pharmaceutical Sciences 05, no. 06 (2018): 5142–47. https://doi.org/10.5281/zenodo.1301279.

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<strong><em>Introduction: </em></strong><em>The three main causes of respiratory related injuries of anesthesia are inadequate ventilation, esophageal intubation and difficult tracheal intubation. 17% of all respiratory related injuries are due to difficult intubation and it accounts for 28% of anesthesia related deaths’. Airway maintenance during anesthesia is crucial for adequate oxygenation and ventilation and failure to secure airway can lead to tissue hypoxia and ultimately death. </em> <strong><em>Subjects and Methods:</em></strong><em> This study involved 126 patients of both genders, aged between I8-70 years undergoing general anesthesia with endotracheal intubation on elective lists Difficult intubation was predicted on restricted neck movement (<80°) and was confirmed on IDS. IDS diagnosis was taken as gold standard and results of restricted neck movement were evaluated accordingly. Written informed consent was taken from every patient.</em> <strong><em>Results:</em></strong><em> The age of the patients ranged from 18 years to 70 years with a mean of 42.49 + 14.56 years. There were 64 (50.8%) male and 62 (49.2%) female patients in the study group. There were 52 (41.3%) obese patients. Difficult intubation was confirmed in 90 (71.4%) patients on intubation difficulty scale (as per operational definition)1. The frequency of difficult intubation was higher among obese patients (80.8% vs. 64.9%; p 0.052) however the difference was insignificant. There were 90 (71.4%) true positive patients with 36 false positive patients. It yielded a positive predictive value of 71.4% for restricted neck movement in the prediction of difficult intubation taking IDS as gold standard. Similar positive predictive value was observed across age, gender and obesity groups.</em> <strong><em>Conclusion:</em></strong><em> The positive predictive value of restricted neck movement (<80°) was found to be 71.4% in predicting difficult intubation among patients undergoing general anesthesia with endotracheal intubation on elective list while taking intubation difficulty scale as the gold standard.</em> <strong>Keywords:</strong><em> Difficult Intubation. Intubation Difficulty Scale. Restricted Neck Movement.</em>

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7

Sawyer, Taylor, Elizabeth E. Foglia, Anne Ades, et al. "Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: a report from the National Emergency Airway Registry for Neonates." Archives of Disease in Childhood - Fetal and Neonatal Edition 104, no. 5 (2019): F461—F466. http://dx.doi.org/10.1136/archdischild-2018-316336.

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ObjectiveTo determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU).DesignRetrospective review of prospectively collected data on intubations performed in the NICU from the National Emergency Airway Registry for Neonates.SettingTen academic NICUs.PatientsNeonates intubated in the NICU at each of the sites between October 2014 and March 2017.Main outcome measuresDifficult intubation was defined as one requiring three or more attempts by a non-resident provider. Patient (age, weight and bedside predictors of difficult intubation), practice (intubation method and medications used), provider (training level and profession) and outcome data (intubation attempts, adverse events and oxygen desaturations) were collected for each intubation.ResultsOut of 2009 tracheal intubations, 276 (14%) met the definition of difficult intubation. Difficult intubations were more common in neonates <32 weeks, <1500 g. The difficult intubation group had a 4.9 odds ratio (OR) for experiencing an adverse event and a 4.2 OR for severe oxygen desaturation. Bedside screening tests of difficult intubation lacked sensitivity (receiver operator curve 0.47–0.53).ConclusionsDifficult intubations are common in the NICU and are associated with adverse event and severe oxygen desaturation. Difficult intubations occur more commonly in small preterm infants. The occurrence of a difficult intubation in other neonates is hard to predict due to the lack of sensitivity of bedside screening tests.

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Imtiaz, Sana, Madiha Zafar, Mariam Waheed, Lala Rukh Bangash, Varda Baloch, and Mubashra Hamza. "Diagnostic Accuracy of Neck Circumference and Thyromental Distance Ratio for Assessing Difficult Intubation in Obese Patients: a Validation Study." Pakistan Journal of Medical and Health Sciences 16, no. 1 (2022): 612–15. http://dx.doi.org/10.53350/pjmhs22161612.

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Various tools for airway assessment are include Mallampati score, upper lip bite test, Wilson scoring and extent of mouth opening; none have high investigative precision especially in obese patients. Objectives: To assess the diagnostic accuracy of neck circumference and thyromental distance ratio for assessing difficult intubation in obese patients using intubation difficulty score as gold standard. Setting: Department of Anesthesiology in East and West operation theatres of Mayo hospital Lahore. Duration: 12 months (From Oct 2015 – Oct 2016) Sample Size: 220 obese patients Methods: Patients undergoing elective surgery were enrolled. Height, weight and body mass index was documented. At the cricoid cartilage level, the neck circumference was measured. All tracheal intubations were conducted by a three-year-experienced anaesthesiologist who was unaware of the study's findings. Cormack and Lehane's grading system was used to rate the laryngoscopy image. Difficult intubation was assessed according to intubation difficulty scoring. Results: The diagnostic accuracy of neck circumference and thyromental distance ratio in assessment of difficulty intubation (DI) among obese patients was 47%, sensitivity 85% and specificity of 37%. Conclusion: NC/TM ratio was a good interpreter in assessing difficult intubation in obese patients. This variable can be incorporated in our preoperative assessment for difficult intubation (DI). It is simple, requires very less time and is economical. Keywords: Airway management, obese, difficult intubation, neck circumference, laryngoscopy, tracheal intubation.

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9

Chan, Gene Wai Han, Chew Yian Chai, Joy Su-Yue Teo, Calvin Kai En Tjio, Mui Teng Chua, and Calvin A. III Brown. "Emergency airway management in a Singapore centre: A registry study." Annals of the Academy of Medicine, Singapore 50, no. 1 (2021): 42–51. http://dx.doi.org/10.47102/annals-acadmedsg.2020331.

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ABSTRACT Introduction: Intubations in the emergency department (ED) are often performed immediately without the benefit of pre-selection or the ability to defer. Multicentre observational data provide a framework for understanding emergency airway management but regional practice variation may exist. We aim to describe the intubation indications, prevalence of difficult airway features, peri-intubation adverse events and intubator characteristics in the ED of the National University Hospital, Singapore. Methods: We conducted a prospective observational study over a period of 31 months from 1 March 2016 to 28 September 2018. Information regarding each intubation attempt, such as indications for intubation, airway assessment, intubation techniques used, peri-intubation adverse events, and clinical outcomes, was collected and described. Results: There were 669 patients, with male predominance (67.3%, 450/669) and mean age of 60.9 years (standard deviation [SD] 18.1). Of these, 25.6% were obese or grossly obese and majority were intubated due to medical indications (84.8%, 567/669). Emergency physicians’ initial impression of difficult airway correlated with a higher grade of glottis view on laryngoscopy. First-pass intubation success rate was 86.5%, with hypoxia (11.2%, 75/669) and hypotension (3.7%, 25/669) reported as the two most common adverse events. Majority was rapid sequence intubation (67.3%, 450/669) and the device used was most frequently a video laryngoscope (75.6%, 506/669). More than half of the intubations were performed by postgraduate clinicians in year 5 and above, clinical fellows or attending physicians. Conclusion: In our centre, the majority of emergency intubations were performed for medical indications by senior doctors utilising rapid sequence intubation and video laryngoscopy with good ffirst-attempt success. Keywords: Difficult airway, emergency services, intubation, peri-intubation adverse events, rapid sequence induction

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Thampi, Suma Mary, Serina Ruth Salins, Divya P. Jacob, and Ahwad Sheetal Avinash. "The Feeding Tube- a Simple Yet Handy Aid to Intubate an Unanticipated Difficult Pediatric Airway." Journal of Nepal Medical Association 53, no. 198 (2015): 141–43. http://dx.doi.org/10.31729/jnma.2778.

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Pediatric intubation requires certain unique set of additional skills compared to intubating adults. The challenges of successfully intubation of a child increases as the age and size of the child decrease and are compounded when airway difficulties arise for various reasons. Often in the rural setting, such procedures may have to be carried out by health care personnel who get trained on-the-job, and in the absence of adequate technological back-up. This leads to an increased incidence of failed intubations which can have devastating complications, especially in the pediatric age group. We describe a simple technique which helped us while intubate a 40-day old infant, without any major catastrophes. Keywords: airway management; infant; newborn; intubation; endotracheal.

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11

Combes, Xavier, Bertrand Le Roux, Powen Suen, et al. "Unanticipated Difficult Airway in Anesthetized Patients." Anesthesiology 100, no. 5 (2004): 1146–50. http://dx.doi.org/10.1097/00000542-200405000-00016.

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Background Management strategies conceived to improve patient safety in anesthesia have rarely been assessed prospectively. The authors undertook a prospective evaluation of a predefined algorithm for unanticipated difficult airway management. Methods After a 2-month period of training in airway management, 41 anesthesiologists were asked to follow a predefined algorithm for management in the case of an unanticipated difficult airway. Two different scenarios were distinguished: "cannot intubate" and "cannot ventilate." The gum elastic bougie and the Intubating Laryngeal Mask Airway (ILMA) were proposed as the first and second steps in the case of impossible laryngoscope-assisted tracheal intubation, respectively. In the case of impossible ventilation or difficult ventilation, the IMLA was recommended, followed by percutaneous transtracheal jet ventilation. The patient's details, adherence rate to the algorithm, efficacy, and complications of airway management processes were recorded. Results Impossible ventilation never occurred during the 18-month study. One hundred cases of unexpected difficult airway were recorded (0.9%) among 11,257 intubations. Deviation from the algorithm was recorded in three cases, and two patients were wakened before any alternative intubation technique attempt. All remaining patients were successfully ventilated with either the facemask (89 of 95) or the ILMA (6 of 95). Six difficult-ventilation patients required the ILMA before completion of the first intubation step. Eighty patients were intubated with the gum elastic bougie, and 13 required a blind intubation through the ILMA. Two patients ventilated with the ILMA were never intubated. Conclusion When applied in accordance with a predefined algorithm, the gum elastic bougie and the ILMA are effective to solve most problems occurring during unexpected difficult airway management.

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Maiorov, M. O., D. V. Federiakin, E. V. Belevskii, V. N. Silaev, and S. I. Tokareva. "Prognostic value of the intubation difficulty scale in bariatric surgery." Messenger of ANESTHESIOLOGY AND RESUSCITATION 20, no. 2 (2023): 29–35. http://dx.doi.org/10.24884/2078-5658-2022-20-2-29-35.

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The objective was to assess the predictive value of the risk scale for difficult intubation in obese patients. Materials and methods. The object of the study was 110 patients (90 women and 20 men) operated on as planned in 2022. The mean age of the patients was 42 ± 11 years. The median body mass index (BMI) was 43.7 kg/m 2 (Q1–Q3: 37.9–49.1). All patients underwent a standard preoperative examination with the identification of the risk of difficult airways according to the intubation difficulty scale (IDS): mouth opening, neck mobility, mandibular protrusion, Mallampati class, sternomental and thyromental distances, and history of previous intubations were assessed. Results. Difficult intubation (3–4 degrees according to Cormack–Lehane) were detected in 19 patients (17.3 %). ROC-analysis revealed the dependence of the probability of difficult intubation on the total points on the intubation difficulty scale. The area under the ROC curve was 0.809 ± 0.063 with 95 % CI: 0.685 – 0.932. The model was statistically significant (p < 0.001). The cut-off point value for the total points on the intubation difficulty scale, which corresponded to the highest value of the Youden index, was 4. The sensitivity and specificity of the model were 100.0 % and 47.3 %, respectively. Significant differences (p < 0.001) were found in the analysis of the risk of difficult intubation depending on the total points on the intubation difficulty scale. The most significant differences (p < 0.001) were demonstrated by the mouth opening width and neck mobility. There were no differences (p = 0.547) when analyzing the history of difficult airways and nighttime snoring. Conclusion. Overall, the intubation difficulty scale showed predictive value in terms of assessing the risk of difficult airways (p = 0.002, χ2 = 13.230). The most reliable indicators for predicting the risks of difficult intubation were mouth opening less than 4 cm (p < 0.001, χ2 = 11.185) and head and neck flexion in the atlanto-occipital joint less than 90о (p < 0.001, χ2 = 10.858). Assessment of thyromental and sternomental distances, mandibular protrusion ability, and Mallampati class also showed statistical significance. Prior history of difficult intubation and nighttime snoring showed no statistically significant risk in predicting difficult airways (p = 0.547, χ2 = 0.363).

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13

Gupta, Ruchi, Baljit Singh, Ravi Mahajan, and Balbir Chhabra. "Difficult Intubation." Anesthesia & Analgesia 83, no. 4 (1996): 890. http://dx.doi.org/10.1097/00000539-199610000-00056.

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14

Lagerkranser, Michael. "Difficult intubation." Acta Anaesthesiologica Scandinavica 41, S110 (1997): 65–66. http://dx.doi.org/10.1111/j.1399-6576.1997.tb05504.x.

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Gupta, Ruchi, Baljit Singh, Ravi Mahajan, and Balbir Chhabra. "Difficult Intubation." Anesthesia & Analgesia 83, no. 4 (1996): 890. http://dx.doi.org/10.1213/00000539-199610000-00056.

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16

James, R. H. "Difficult intubation." Anaesthesia 55, no. 11 (2000): 1133. http://dx.doi.org/10.1046/j.1365-2044.2000.01766-8.x.

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17

Williamson, R. "DIFFICULT INTUBATION." Lancet 331, no. 8578 (1988): 175–76. http://dx.doi.org/10.1016/s0140-6736(88)92741-9.

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18

Cossham, P. S., MartinB Allen, PeterA Coe, T. A. King, and R. M. Towey. "DIFFICULT INTUBATION." Lancet 330, no. 8566 (1987): 1034. http://dx.doi.org/10.1016/s0140-6736(87)92607-9.

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19

Nathan, A. S., J. G. Scott, and M. Mohandas. "Difficult intubation." Anaesthesia 41, no. 6 (1986): 664–65. http://dx.doi.org/10.1111/j.1365-2044.1986.tb13088.x.

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20

Barham, C. J. "Difficult intubation." Baillière's Clinical Anaesthesiology 1, no. 3 (1987): 779–98. http://dx.doi.org/10.1016/s0950-3501(87)80034-x.

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21

WILLIAMSON, J. A., and W. B. RUNCIMAN. "Difficult intubation." British Journal of Anaesthesia 72, no. 3 (1994): 366. http://dx.doi.org/10.1093/bja/72.3.366-b.

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22

de Mello, W. F., and J. Restall. "Difficult Intubation." Obstetric Anesthesia Digest 10, no. 4 (1991): 237. http://dx.doi.org/10.1097/00132582-199101000-00068.

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23

de Mello, W. F., and J. Restall. "Difficult intubation." Canadian Journal of Anaesthesia 37, no. 4 (1990): 486. http://dx.doi.org/10.1007/bf03005634.

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24

Wu, Meng-Yu, Giou-Teng Yiang, Jian-Yu Ke, Chien-Sheng Chen, Po-Chen Lin, and Yu-Long Chen. "Role of Trachway versus Conventional Modes of Intubation in Difficult Airway Management in COVID-19 Setups." Emergency Medicine International 2021 (February 25, 2021): 1–6. http://dx.doi.org/10.1155/2021/6614523.

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Difficult airway management in critically ill patients remains a difficult task associated with high morbidity and mortality rates. In difficult airway populations, prompt effective intubation is more important to prevent hypoxia and neurological injury. During the ongoing COVID-19 pandemic, prolonged intubation time and repeated intubation can lead to an increase in the risk of infection. Therefore, digital devices can shorten intubation times and decrease the risk of infection among clinical staff. The advantages of the Trachway videolight intubating stylet suit these conditions. Trachway stylet intubation is an effective method for video laryngoscopy to enhance patient safety and improve the intubation success rate. However, a few studies have focused on the effect of stylet intubation by reducing repeated intubation and oxygen desaturation. In this study, we reviewed current data of Trachway intubation and shared our four major training scenarios in Taipei Tzu Chi Hospital via the Trachway videolight intubating stylet system for emergency intubation, comparing them with other modes of intubation.

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Bellhouse, C. P., and C. Doré. "Criteria for Estimating Likelihood of Difficulty of Endotracheal Intubation with the Macintosh Laryngoscope." Anaesthesia and Intensive Care 16, no. 3 (1988): 329–37. http://dx.doi.org/10.1177/0310057x8801600315.

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Many anatomical factors in difficult intubation at direct laryngoscopy have been evaluated. Lateral radiographs were taken of nineteen patients in whom tracheal intubation proved particularly difficult, and fourteen patients whose intubation was reasonably straightforward. Stepwise discriminant analysis was used to select the best measurements for distinguishing between the difficult and straightforward groups. The variables which together are most reliable in predicting likely difficulty in intubation are reduced atlanto-occipital extension, reduced mandibular space, and lastly, increased antero-posterior thickness of the tongue. A formula and graph have been derived to relate these variables with likelihood of difficulty, and a method has been described of applying this information at the bedside, without using X-ray examination, to estimate the likelihood of difficulty in intubating a new patient. Eighteen months’ experience of the application of this clinical evaluation have so far found it reliable.

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Nath, G., and M. Sekar. "Predicting Difficult Intubation—A Comprehensive Scoring System." Anaesthesia and Intensive Care 25, no. 5 (1997): 482–86. http://dx.doi.org/10.1177/0310057x9702500505.

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A study was conducted in an attempt to devise a simple and more accurate method of predicting difficult intubation. Prospective assessments were made in 282 patients and retrospective assessment in 16 patients with regard to 21 anatomical factors which were correlated with the laryngoscopic view at intubation. Twelve factors correlated significantly with difficult intubation. Four of these were eliminated after multifactorial analysis. A scoring system was devised, assigning points to each variable based on its discriminative value. A score of 6 or more correctly identified 22 out of the 23 difficult intubations and there were 50 false positives (sensitivity, specificity and PPV of 96%, 82% and 31% respectively). When negative scoring was done for factors favouring easy intubation, false positives were reduced to 36, but only 20 difficult cases could be identified correctly.

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Mathew, Johann. "Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients." Journal of Research & Innovation in Anesthesia 1, no. 2 (2016): 41–44. http://dx.doi.org/10.5005/jp-journals-10049-0011.

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ABSTRACT Background Anticipating a difficult airway is of prime importance to an anesthesiologist. Data available are inconclusive to say that tracheal intubation is more difficult in the obese. The deficiency occurring with individual factors can be avoided by adopting multiple airway assessment factors. In this study, we aim to compare the incidence of difficult intubation between obese and nonobese patients and compare three predictors of difficult intubation. Study design Prospective observational study. Materials and methods About 250 patients were assigned to two groups, obese and nonobese based on their body mass index. Preoperatively, neck circumference (NC), mouth opening, thyromental distance (TMD), neck extension, NC/TM ratio, Mallampati classification (MPC), and Wilson score (WS) were calculated. Difficulty of intubation was assessed using the intubation difficulty scale (IDS). All tracheal intubations were performed by anesthetists with more than 2 years of experience. Statistical analysis used Data analysis was done with the help of Statistical Package for the Social Sciences (SPSS) version 15, MedCalc version 11, and Epi data software. Qualitative data are presented with the help of frequency and percentage table, and association among various study parameters is done with chi-square test. Results The incidence of difficult intubation determined by the IDS (≥5) was more frequent in the obese group (88.6% in obese vs 11.4% in nonobese). Of the three variables, WS was found to be statistically significant (p < 0.005). Neck circumference to thyromental ratio is a new predictor for difficult tracheal intubation (DTI). But an NC/TM ratio of ≥5 gives high false positive for our population. How to cite this article Mathew J, Gvalani SK. Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients. Res Inno in Anesth 2016;1(2):41-44.

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Deepak, Chandrakant Koli, S. Katkade Sandip, D. Latkar Prajakta, and H. Mehta Hemant. "Airway Management In Patients With Traumatic Cervical Spine Injury For Emergency Surgery: A Case Series." British Journal of Medical and Health Research 10, no. 03 (2023): 26–35. https://doi.org/10.5281/zenodo.7805004.

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Patients with traumatic cervical spine injuries who require surgical intervention pose a significant challenge to anaesthesiologists. Airway management inherently involves cervical spine movements that may aggravate pre-existing injury. There is currently no agreement on the technique for intubating these patients. We present three patients with cervical spine traumatic injuries and neurological symptoms posted for emergency cervical spine fixation surgery. All intubations were done by direct laryngoscopy with video laryngoscope and endotracheal tube then railroaded over Boogie with manual in-line Immobilization. We can conclude that the video laryngoscope assisted intubation has several advantages in the care of patients posted for emergency cervical spine fracture fixation. <strong>Keywords: </strong>Trauma, cervical spine injury, emergency surgery, videolaryngoscope, difficult intubation.

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Shin, Myungju, Sun Joon Bai, Ki-Young Lee, Ein Oh, and Hyun Joo Kim. "Comparing McGRATH® MAC, C-MAC®, and Macintosh Laryngoscopes Operated by Medical Students: A Randomized, Crossover, Manikin Study." BioMed Research International 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/8943931.

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We hypothesized that the McGRATH MAC would decrease the time of intubation compared to C-MAC for novices. Thirty-nine medical students who had used the Macintosh blade to intubate a manikin fewer than 3 times were recruited. The participants performed sequential intubations on the manikin in two simulated settings that included a normal airway and a difficult airway (tongue edema). The intubation time, success rate of intubation, Cormack-Lehane grade at laryngoscopy, and difficulty using the device were recorded. Each participant was asked to identify the device that was most useful. The intubation time decreased significantly and by a similar amount to the McGRATH MAC and C-MAC compared to the Macintosh blade (P<0.001andP=0.017, resp.). In the difficult airway, the intubation times were similar among the three devices. The McGRATH MAC and C-MAC significantly increased the success rate of intubation, improved the Cormack-Lehane grade, and decreased the difficulty score compared to the Macintosh blade in both airway settings. The majority of participants selected the McGRATH MAC as the most useful device. The McGRATH MAC and C-MAC may offer similar benefits for intubation compared to the Macintosh blade in normal and difficult airway situations.

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Fukutome, T., K. Amaha, K. Nakazawa, T. Kawamura, and H. Noguchi. "Tracheal Intubation through the Intubating Laryngeal Mask Airway (LMA-Fastrach™) in Patients with Difficult Airways." Anaesthesia and Intensive Care 26, no. 4 (1998): 387–91. http://dx.doi.org/10.1177/0310057x9802600408.

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The intubating laryngeal mask airway was used in 31 adult patients in whom tracheal intubation was known or suspected to be difficult. The intubating laryngeal mask airway was successfully inserted in 30 patients and provided a clinically patent airway. In the remaining one patient it was impossible to insert the device correctly. Tracheal intubation through the device was successful in 28 of 30 patients (93%). These results suggest that the intubating laryngeal mask airway has a potential role for tracheal intubation in adult patients with difficult airways.

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Aoyama, K., and I. Takenaka. "Difficult laryngoscopy and difficult intubation." Anaesthesia 54, no. 8 (1999): 811–12. http://dx.doi.org/10.1046/j.1365-2044.1999.01042.x.

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Gibson, Bruce. "Difficult Intubation and Difficult Airway." Anesthesia & Analgesia 93, no. 6 (2001): 1624. http://dx.doi.org/10.1097/00000539-200112000-00065.

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Dimaculangan, Dennis P. "Difficult Intubation and Difficult Airway." Anesthesia & Analgesia 93, no. 6 (2001): 1624. http://dx.doi.org/10.1097/00000539-200112000-00066.

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Rajbanshi, Lalit Kumar, and Satyendra Narayan Singh. "Comparison of Berman and Ovassapian Intubating airways for fiberoptic orotracheal intubation in anaesthetized patient." Journal of Society of Anesthesiologists of Nepal 3, no. 2 (2016): 69–73. http://dx.doi.org/10.3126/jsan.v3i2.15616.

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Background: Intubating oral airways are widely used during fibreoptic orotracheal intubationin order to improve the bronchoscopic visualisation of the glottis and facilitate the procedure. This study compares the visualisation of the glottic opening with bronchoscope using Berman or Ovassapian intubating airway.Methods: We conducted a randomised comparative prospective study one hundred twenty patients with no clinical indicators of the difficult airway. The two oral intubating Berman and Ovassapian airways were compared during fibreoptic endotracheal intubation in anaesthetized patients. The bronchoscopic view, bronchoscopic time, and the total time for intubation were compared.Result: The bronchoscopic view was significantly better with Berman intubating airway (unobstructed view 74%) as compared to the Ovassapian airway (unobstructed 38.4%) (p-value 0.002). The Berman airway provided a significantly shorter duration for visualisation of the vocal cord and intubation of trachea in comparison to the Ovassapian airway.Conclusion: Berman airway provided a better bronchoscopic view as well as shorter bronchoscopic and intubation time as compared to the Ovassapian airway.

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Williamson, J. A., R. K. Webb, S. Szekely, E. R. N. Gillies, and A. V. Dreosti. "Difficult Intubation: An Analysis of 2000 Incident Reports." Anaesthesia and Intensive Care 21, no. 5 (1993): 602–7. http://dx.doi.org/10.1177/0310057x9302100518.

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The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the incidence and circumstances of problems with endotracheal intubation; 85 (4%) indicated difficulties with intubation. One third of these were emergency cases, one third involved an initially unassisted trainee and one fifth were outside normal working hours. Failure to predict a difficult intubation was reported in one third of the cases, with another quarter presenting serious difficulty despite preoperative prediction. Difficulties with ventilation were experienced in 1 in 7 of the 85 reports; there was one cardiac arrest, but no death. Endotracheal intubation was not achieved in one fifth of the cases. The commonest complications reported amongst the 85 incidents were oesophageal intubation (18 cases), arterial desaturation (15 cases), and reflux of gastric contents (7 cases). Emergency trans-tracheal airways were required in 5 cases. Obesity, limited neck mobility and mouth opening, and inadequate assistance together accounted for two thirds of all the contributing factors. The most successful intubation aid in this series was a gum elastic bougie. A capnograph contributed to management in 28% and a pulse oximeter in 12% of the cases in which they were used. The most serious desaturations were associated with accidental oesophageal intubation. These data suggest a lack of reliable preoperative assessment techniques and skills for the prediction of difficult intubations. They also suggest the need for a greater emphasis on ensuring that the necessary equipment is available, and on teaching and learning drills for difficult intubation and any associated difficulty with ventilation.

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Lim, Su Sian, Kevin Wei Shan Ng, Sook Hui Chaw, Ili Syazana Jamal Azmi, Mayura Hanis Ahmad Damanhuri, and Ina Ismiarti Shariffuddin. "Clinical evaluation of Ambu® AuraGain™ as a conduit for intubation in paediatric patients: a descriptive study." Malaysian Journal of Anaesthesiology 1, no. 1 (2022): 23–31. http://dx.doi.org/10.35119/myja.v1i1.13.

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Introduction: Many paediatric difficult airway guidelines have recommended supraglottic airway devices (SGAs) as an indispensable tool in the algorithm for managing failed intubation scenarios. It is used for maintaining ventilation in a difficult or failed intubation. The newer generation SGAs can be used as intubating conduits in patients with a difficult airway. The aim of this study was to report the efficacy and safety of Ambu® AuraGain™(Ambu A/S, Ballerup, Denmark) as a conduit for intubation in paediatric patients.Methods: Local ethics approval and informed consent were obtained before patient enrolment. Sixteen patients aged 3–12 years old were recruited. Following the induction of anaesthesia and insertion of the Ambu AuraGain, fibreoptic guided intubation was performed via the SGA. The primary outcome was the time taken for successful tracheal intubation. Secondary outcomes included the number of attempts and the time required for insertion and removal of Ambu AuraGain, oropharyngeal leak pressures, fibre optic grading of glottic views, and complications from the intubation.Results: The overall success rate concerning intubation was 87.5% (14 patients), with a mean intubation time of 57.0 ± 39.4 seconds. Successful first attempt intubations were achieved in 13 patients (81.3%). The results showed easy removal of the Ambu AuraGain device with a mean SGA removal time of 27.2 ± 19.8 seconds. No significant complications occurred throughout the study.Conclusion: The Ambu AuraGain device can be considered safe and effective as a conduit for intubation in paediatric patients.

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KING, HWA-KOU, LONG-FONG WANG, AHSANUL K. KHAN, and DANIEL J. WOOTEN. "Translaryngeal guided intubation for difficult intubation." Critical Care Medicine 15, no. 9 (1987): 869–71. http://dx.doi.org/10.1097/00003246-198709000-00014.

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Sellers, W. F. S., and S. Yogendran. "Difficult tracheal intubation." Anaesthesia 42, no. 11 (1987): 1243. http://dx.doi.org/10.1111/j.1365-2044.1987.tb05264.x.

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Millar, S. W. "Unexpected difficult intubation." Anaesthesia 42, no. 9 (1987): 1021–22. http://dx.doi.org/10.1111/j.1365-2044.1987.tb05392.x.

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KIDD, J. F., A. DYSON, and I. P. LATTO. "Successful difficult intubation." Anaesthesia 43, no. 6 (1988): 437–38. http://dx.doi.org/10.1111/j.1365-2044.1988.tb06625.x.

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Marks, R. J. "Successful difficult intubation." Anaesthesia 46, no. 1 (1991): 72. http://dx.doi.org/10.1111/j.1365-2044.1991.tb09329.x.

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FRERK, C. M. "Predicting difficult intubation." Anaesthesia 46, no. 12 (1991): 1005–8. http://dx.doi.org/10.1111/j.1365-2044.1991.tb09909.x.

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Combes, X., and G. Dhonneur. "Difficult tracheal intubation." British Journal of Anaesthesia 104, no. 2 (2010): 260–61. http://dx.doi.org/10.1093/bja/aep384.

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Kubota, Yukio, Yoshiro Toyoda, Hiroshi Kubota, and Akira Asada. "Difficult Endotracheal Intubation." Anesthesia & Analgesia 75, no. 3 (1992): 461. http://dx.doi.org/10.1213/00000539-199209000-00027.

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Thapar, A., A. George, and P. Tassone. "Difficult nasogastric intubation." Clinical Otolaryngology 32, no. 4 (2007): 316. http://dx.doi.org/10.1111/j.1365-2273.2007.01434.x.

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WILSON, M. E., D. SPIEGELHALTER, J. A. ROBERTSON, and P. LESSER. "PREDICTING DIFFICULT INTUBATION." British Journal of Anaesthesia 61, no. 2 (1988): 211–16. http://dx.doi.org/10.1093/bja/61.2.211.

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BELLHOUSE, C. P., and C. DORÉ. "PREDICTING DIFFICULT INTUBATION." British Journal of Anaesthesia 62, no. 4 (1989): 469. http://dx.doi.org/10.1093/bja/62.4.469.

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WILSON, M. E., and D. J. SPIEGELHALTER. "PREDICTING DIFFICULT INTUBATION." British Journal of Anaesthesia 62, no. 4 (1989): 469. http://dx.doi.org/10.1093/bja/62.4.469-a.

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Hung, Orlando, and Michael Murphy. "Unanticipated difficult intubation." Current Opinion in Anaesthesiology 17, no. 6 (2004): 479–81. http://dx.doi.org/10.1097/00001503-200412000-00003.

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DEUER, A., M. N. SCHREIBER, J. GRAMER, and A. HNEFEID. "A1054 DIFFICULT INTUBATION." Anesthesiology 73, no. 3A (1990): NA. http://dx.doi.org/10.1097/00000542-199009001-01052.

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