Volume 65, Issue 5 (3 2007)                   Tehran Univ Med J 2007, 65(5): 1-5 | Back to browse issues page

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Hussain khan Z, Mirazimi F. Forward movement of the lower mandible in the prediction of difficult intubation: a prospective study. Tehran Univ Med J. 2007; 65 (5) :1-5
URL: http://tumj.tums.ac.ir/article-1-779-en.html
Abstract:   (4093 Views)
Background: Failed endotracheal intubation is one of the principal causes of morbidity and mortality in anesthetized patients. If the anesthetist can anticipate which patients may be more difficult to intubate, can reduce the risks of anesthesia greatly and be more prepared for any difficulties that may occur. The aim of this study was to investigate the inability of patients to protrude the lower jaw in predicting difficult intubation.
Methods: In this prospective study, we enrolled 300 patients, above 16 years of age or older, who were scheduled for elective surgery. For all of the patients, before each operation, a single anesthesiologist measured the temporomandibular mobility, which was defined as the difference between the distances, from the lower incisors to the upper incisors in a neutral position and at maximum mandibular protrusion. At the time of intubation, another anesthesiologist, blinded to the preoperative airway assessment test, performed a laryngoscopy in which the laryngoscopic view of the larynx was determined according to the Cormack and Lehane scoring system. Difficult intubation was defined as laryngoscopic views of grade III and IV.
Results: Twenty-one patients were identified as having difficult intubation. Only one patient could not be intubated. The forward movement of the mandible was significantly greater in patients with easy intubation compared to those with difficult intubation (6.42±1.95 mm vs. 3.58±1.26 mm respectively, P<0.001). The use of a cut-off point of less than 5 mm for prediction of difficult intubation showed a sensitivity of 92.86% and a specificity of 70.43%.
Conclusion: The forward movement of the mandible is significantly greater in patients with easy intubation compared those with difficult intubation Although infrequent difficulties may arise, most patients that do not have indicators of difficult intubation will be easy to intubate under anesthesia.
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