Sadqa Aftab, Dillo Raja, Shamsunnisa Rashdi, Asma Khalid.
Preoperative assessment of risk factors for difficult intubation.
Pak J Surg Jan ;24(1):60-4.

Objective: To determine a clinically useful variable for predicting difficult tracheal intubation in patients with seemingly normal airways. Design & Duration: Quasi experimental study from September 2004 to March 2005. Setting: Department of Anaesthesiology, Civil Hospital, Karachi. Patients: A total of 150 patients requiring tracheal intubation for elective surgery. Methodology: An airway assessment test was conducted on each patient prior to general anaesthesia, with respect to mouth opening, thyromental distance, Oropharyngeal (Mallampati) classification, neck movement, length of mandibular ramus, ability to prognath and body mass index. After induction of anaesthesia, the laryngeal view during laryngoscopy was graded and then the ability to intubate was assessed. Results: Incidence of difficult intubation occurred in 4(2.6%) cases out of 150 patients. Airway test that were significant for predicting difficult tracheal intubation was inter-incisor distance of 3cms, Mallampati class-3, neck circumference >40cms and subluxation grade-2 with sensitivity of 100%, 3.33%, 20% and 17.64% respectively. Conclusion: Our study concludes that inter-incisor distance of 2cms was the most sensitive predictor of difficult intubation followed by Mallampati class-3, neck circumference >40cms and subluxation grade-2.

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