Abstract
Background: HMDR is used to predict a difficult airway preoperatively
Aim: The aim of the study is to predict difficult airway in non obese population using hyomental distance. To correlate cormack- lehane with HMD ratio
Methods: Mallampati class & ULBT score recorded pre operatively. HMDe & HMDn distance measured in 2 positions using 5MHZ curvilinear ultrasonogram transducer. HMD ratio calculated. Pre-epiglottic soft tissue thickness at level of thyrohyoid membrane with linear 10 MHZ transducer
Patient premedicated, induced & adequate muscle relaxation was given. Macintosh laryngoscope blade 3 & 4 size introduced to visualize the glottis structures. Difficult intubation will be assessed using Cormack-lehane grading
Results: Total of 100 patients were included in the study, 52 patients were male and 48 patients were female. 51% of study population comes under overweight group. 56% of study population falls under mallampatti grade 2. 61% of study population has HMDe >5.3. 61% of study population has HDMn>5.5. 60% of study group has HDM ratio >1.2. Difficult intubation was seen among 38% of study population.
Keywords: Difficult airway, HMD ratio, cormack-lehane score , ultrasound.
References
- Wilson, M., Spiegelhalter, D., Robertson, J., Lesser, P. (1988). Predicting difficult intubation. Br J Anaesth. http://dx.doi.org/10.1093/bja/61.2.211
- Kalezić, N., Milosavljević, R., Paunović, I., Živaljević, V., Diklić, A., Matić, D. (2009). The incidence of difficult intubation in 2000 patients undergoing thyroid surgery-singlecenter experience. Vojnosanit Pregl. http://dx.doi.org/10.2298/VSP0905377K
- Noppens, R. (2012). Airway management in the intensive care unit. ActaClin Croat.
- Calder, I., Calder, J., Crockard, H. (1995). Difficult direct laryngoscopy in patients with cervical spine disease. Anaesthesia. http://dx.doi.org/10.1111/j.1365-2044.1995.tb06135.x
- Juvin, P., Lavaut, E., Dupont, H., Lefevre, P., Demetriou, M., Dumoulin, J. (2003). Difficult tracheal intubation is more common in obese than in lean patients. AnesthAnalg. http://dx.doi.org/10.1213/01.ANE.0000072547.75928.B0
- Takenaka, I., Iwagaki, T., Aoyama, K., Ishimura, H., Kadoya, T. (2006). Preoperative evaluation of extension capacity of the occipitoatlantoaxial complex in patients with rheumatoid arthritis: Comparison between the Bellhouse test and a new method, hyomental distance ratio. Anesthesiology. http://dx.doi.org/10.1097/00000542-200604000-00011
- Huh, J., Shin, H., Kim, S., Yoon, T., Kim, D. (2009). Diagnostic predictor of difficult laryngoscopy: The hyomental distance ratio. Anesth Analg. http://dx.doi.org/10.1213/ane.0b013e31818fc347
- Wojtczak, J. (2012). Submandibular sonography: Assessment of hyomental distances and ratio, tongue size, and floor of the mouth musculature using portable sonography. J Ultrasound Med.
- Samsoon, G., Young, J. (1987). Difficult tracheal intubation: A retrospective study. Anaesthesia. http://dx.doi.org/10.1111/j.1365-2044.1987.tb04039.x
- Cormack, R., Lehane, J. (1984). Difficult tracheal intubation in obstetrics. Anaesthesia. http://dx.doi.org/10.1111/j.1365-2044.1984.tb08932.x
- Rose, D., Cohen, M. (1994). The airway: Problems and predictions in 18,500 patients. Can J Anaesth. http://dx.doi.org/10.1007/BF03009858
- Rao, S., Gowda, V. (2013). Hyomental distance ratio as a diagnostic predictor of difficult laryngoscopy. Indian J Appl Res. http://dx.doi.org/10.15373/2249555X/AUG2013/161
- Honarmand, A., Safavi, M., Ansari, N. (2014). A comparison of between hyomental distance ratios, ratio of height to thyromental, modified Mallamapati classification test and upper lip bite test in predicting difficult laryngoscopy of patients undergoing general anesthesia. Adv Biomed Res. http://dx.doi.org/10.4103/2277-9175.139130
- Lee, A., Fan, L., Gin, T., Karmakar, M., Ngan Kee, W. (2006). A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg. http://dx.doi.org/10.1213/01.ane.0000217211.12232.55
- Shiga, T., Wajima, Z., Inoue, T., Sakamoto, A. (2005). Predicting difficult intubation in apparently normal patients: A meta-analysis of bedside screening test performance. Anesthesiology. http://dx.doi.org/10.1097/00000542-200508000-00027
- Yildiz, T., Korkmaz, F., Solak, M., Toker, K., Erciyes, N., Bayrak, F. (2007). Prediction of difficult tracheal intubation in Turkish patients: A multi-center methodological study. Eur J Anaesthesiol. http://dx.doi.org/10.1017/S026502150700052X
- Kheterpal, S., Martin, L., Shanks, A., Tremper, K. (2009). Prediction and outcomes of impossible mask ventilation: A review of 50,000 anesthetics. Anesthesiology. http://dx.doi.org/10.1097/ALN.0b013e31819b5b87
- Mashour, G., Kheterpal, S., Vanaharam, V., Shanks, A., Wang, L., Sandberg, W. (2008). The extended Mallampati score and a diagnosis of diabetes mellitus are predictors of difficult laryngoscopy in the morbidly obese. AnesthAnalg. http://dx.doi.org/10.1213/ane.0b013e31818a9946
- Ittichaikulthol, W., Chanpradub, S., Amnoundetchakorn, S., Arayajarernwong, N., Wongkum, W. (2010). Modified Mallampati test and thyromental distance as a predictor of difficult laryngoscopy in Thai patients. J Med Assoc Thai.
- Fritscherova, S., Adamus, M., Dostalova, K., Koutna, J., Hrabalek, L., Zapletalova, J. (2011). Can difficult intubation be easily and rapidly predicted?. Biomed Pap Med FacUnivPalacky Olomouc Czech Repub. http://dx.doi.org/10.5507/bp.2011.032
- Perez-Santos, F., Hernandez-Salgado, M., Diaz-Landeira, J., Santana Dominguez, M., Dominguez-Garcia, J., Herrera-Garcia, M. (2011). Usefulness of difficult airway predictors in the emergency department. Emergencias.
- Lundstrøm, L., Vester Andersen, M., Møller, A., Charuluxananan, S., L’hermite, J., Wetterslev, J. (2011). Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients. Br J Anaesth. http://dx.doi.org/10.1093/bja/aer292
Corresponding Author
Dr Amutha Rani R MD
Prof & HOD, Department of Anaesthesiology, Tirunelveli Medical College
DOI: https://dx.doi.org/10.18535/jmscr/v10i3.16
