TITLE:
Clinical Criteria for Airway Assessment: Correlations with Laryngoscopy and Endotracheal Intubation Conditions
AUTHORS:
Gustavo Henrique S. Wanderley, Luciana Cavalcanti Lima, Tânia Cursino de Menezes Couceiro, Waston Vieira Silva, Raquel Queiroz G. A. Coelho, Andrea Cavalcanti C. Lucena, Anne Danielle Santos Soares
KEYWORDS:
Preanesthetic Evaluation; Respiratory System; Airway; Endotracheal Intubation; Measurement Tech-niques; Mallampati; Wilson; Cormack-Lehane
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.7,
September
4,
2013
ABSTRACT: Difficult intubation,
inadequate ventilation and esophageal intubation are the principal causes of
death or brain damage related to airway manipulation. The objective of this
cross-sectional study was to correlate a preanesthetic evaluation that may be
capable of predicting a difficult intubation with the conditions encountered at
laryngoscopy and endotracheal intubation. Eighty-one patients submitted to
general anesthesia were evaluated at a preanesthetic consultation according to
the modified Mallampati classification, the Wilson score and the American
Society of Anesthesiologists (ASA) difficult airway algorithm. Findings were
then correlated with the Cormack-Lehane classification and with the number of
attempts at endotracheal intubation. No statistically significant correlations
were found between the patients’ Mallampati classification and their
Cormack-Lehane grade or between the Mallampati classification and the number of
attempts required to achieve endotracheal intubation. Laryngoscopy proved
difficult in four patients and in all of these cases the Wilson score had been
indicative of a possibly difficult airway, highlighting its good predicting
sensitivity. However, the specificity of this test was low, since another 24
patients had the same Wilson score but were classified as Cormack-Lehane I/II.
Moreover, two patients who had a Wilson score ≥ 4 were also classified as
Cormack-Lehane grade I/II. The study concluded that the Wilson score, although
seldom used in clinical practice, is a highly sensitive predictor of a
difficult airway; its specificity, however, is low.