Prediction of difficult tracheal intubation in thyroid surgery: myth or

Prediction of difficult tracheal intubation in thyroid surgery: myth or

Prediction of difficult tracheal intubation in thyroid surgery: myth or reality?
Candas Ercetin,1 Ayten Saracoglu,2 Nihat Aksakal,3 Beyza Ozcinar,3 Selim Dogan,3 Aysen Yavru,4 Yesim Erbil3
Istanbul Bilim University 1
Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
2 Department of Anesthesiology and Intensive Care, Istanbul Bilim University Medical School Turkey & Difficult Airway Research Collaboration (DARC)
3 Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
4 Department of Anesthesiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
Methods
Following the Ethics Committee approval, 94 patients who were scheduled for
surgery with the indication of benign or malignant thyroidal disease were
included in the study. Patient’s age, gender, body mass index, distances between
upper lip and nose, lower lip and chin, chin and tragus, chin and ear, horizontal
length of chin, neck mobility, range of mouth opening, sternomental distance,
thyromental distance, presence of protruded teeth and mandibula,
macroglossia, Mallampati class were evaluated and recorded. Besides,
Cormack Lehane classification, number of attempts at intubation, size of the
intubation tube, complications and the duration of professional life of the
anesthesiologist were recorded. On direct laryngoscopic view, 13 (13.8%)
patients with Cormack Lehane grade III and IV constituted the Difficult
Intubation Group (Group 1), while 81 (86.2%) patients with Cormack Lehane
grade I and II were evaluated as normal intubation group (Group 2).
Results
There was no significant difference between groups regarding upper
lip - nose distance, lower lip - chin distance, Horizontal length of chin,
Chin - ear distance, Chin - tragus distance, Neck mobility, Range of
mouth opening, Body mass index age and intubation tube size
(p>0.05, Table 1). The incidence of protruded teeth and mandibula,
macroglossia and the rate of auxiliary equipment use were
significantly high in Difficult Intubation Group (p<0.05).
Sternomental and tyromental distances were shorter in Difficult
Intubation Group (p<0.05). Thyroid gland volume and number of
attempts at intubation were significantly lower in Normal Intubation
Group (p<0.05). Logistic regression analysis revealed that risk of
difficult intubation increased 45-fold when sternomental distance
were ≤12 cm, while larger-sized (≥ 70 cm3) thyroid gland and
thyromental distance of ≤ 8 cm increased this risk 41- and 21-fold,
respectively.
Conclusions
Though various factors determining difficult intubation have been reported, the volume of thyroid gland seems to be associated
with the intubation difficulty. We concluded that preoperative thyroid gland volume measurement may be useful for the
prediction of difficult intubation in patients undergoing thyroid surgery.
WAMM2015
2015Dublin
Dublin
WAMM
[email protected]>
http://darc-airway.com
http://darc-airway.com
Istanbul Bilim University Prediction of difficult tracheal intubation in thyroid surgery: myth or reality?
Candas Ercetin,1 Ayten Saracoglu,2 Nihat Aksakal,3 Beyza Ozcinar,3 Selim Dogan,3 Aysen Yavru,4 Yesim Erbil3
1
Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
of Anesthesiology and Intensive Care, Istanbul Bilim University Medical School Turkey & Difficult Airway Research Collaboration (DARC)
3 Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
4 Department of Anesthesiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
2 Department
 We performed this prospective study to investigate the incidence of difficult intubation in the presence of
goiter and to evaluate factors linked to difficult intubation.
 The incidence of protruded teeth and mandibula, macroglossia and the rate of auxiliary equipment use
were significantly high in Difficult Intubation Group (p<0.05).
 Thyroid gland volume and number of attempts at intubation were significantly lower in Normal
Intubation Group (p<0.05).
 Logistic regression analysis revealed that risk of difficult intubation increased 45-fold when sternomental
distance were ≤12 cm, while larger-sized (≥ 70 cm3) thyroid gland and thyromental distance of ≤ 8 cm
increased this risk 41- and 21-fold, respectively.
WAMM 2015 Dublin
[email protected]>
http://darc-airway.com