Značaj mandibulohioidne distance i odnosa hiomentalne distance kao prediktora otežane intubacije u različitim granama hirurgije

Abstract

Uvod: Preoperativna procena anatomskih parametara i kliničkih faktora je važna u otkrivanju pacijenata sa povišenim rizikom za otežanu endotrahealnu intubaciju (OEI). Odnos hiomentalne distance (Hyomental Distance Ratio - HMDR) je odnos između hiomentalne distance – HMD (rastojanje od hioidne kosti do vrha brade) u položaju maksimalne ekstenzije vrata (HMDe) i u neutralnom položaju vrata (HMDn). Mandibulohioidna distanca (MHD) je vertikalno rastojanje od gornje ivice hioidne kosti do ravni donje ivice mandibule u neutralnom položaju vrata. U radu je ispitivana prediktivna vrednost, senzitivnost i specifičnost različitih prediktora OEI, sa posebnim osvrtom na HMDR, hiomentalnu distancu i mandibulohioidnu distancu. Takođe, ispitivano je postojanje eventualnih razlika u senzitivnosti i specifičnosti HMDR i drugih prediktora OEI u zavisnosti od grane hirurgije. Osnovna hipoteza istraživanja bila je da vrednost HMDR manja ili jednaka 1.2 i mandibulohioidna distanca predstavljaju značajne prediktore otežane endotrahealne intubacije u svim granama hirurgije. Metodologija: Istraživanje je obuhvatilo 262 pacijenta koji su podvrgnuti elektivnim hirurškim intervencijama u Kliničkom Centru Srbije (KCS) u periodu od aprila 2011. godine do aprila 2012. godine, a operisani su na Klinikama za urologiju, abdominalnu hirurgiju, ginekologiju, endokrinu hirurgiju i otorinolaringologiju. Pored HMDR, MHD, HMDe i HMDn ispitivani su Mallampati skor i Indeks telesne mase (Body Mass Index - BMI). Kao pokazatelj OEI ispitivane su vrednosti HMDe<5.3 cm, HMDn≤5.5 cm, MHD<2.0 cm, MHD>3.5 cm i HMDR≤1.2. Osnovni ishodi koji su praćeni su: učestalost otežane vizuelizacije larinksa i OEI. Procena postojanja otežane vizuelizacije larinksa i OEI je vršena na osnovu klasifikacije Kormaka i Lihena (Cormack, Lehane) čiji stepeni III i IV su prediktori OEI...

Background: Provision and maintenance of the airway is one of the basic postulates in the work of anaesthesiologists being an integral part of the everyday work in operating rooms and intensive care units. The Hyomental Distance Ratio (HMDR) is the ratio between the Hyomental Distance (HMD) (the distance between the hyoid bone and the tip of the chin) at the extreme of head extension (HMDe) and the one in the neutral position (HMDn). The vertical distance between the mandible and the hyoid bone (mandibulohyoid distance- MHD) was measured in the neutral position of the head. The objective of the paper is to examine the predictive value, sensitivity and specificity of HMDe, MHD, HMDn and HMDR in predicting difficult endotracheal intubation (DEI) in different surgical specialties. Methods: A prospective study included 262 patients that underwent elective surgical operations at the Clinical Centre of Serbia in the period from April 2011 to April 2012. The patients underwent surgical operations at the Urology Clinic, Abdominal Surgery Clinic, Gynaecology Clinic, Endocrine Surgery Clinic and the Otorhinolaryngology Clinic. The following parameters were observed as possible predictors of DEI: HMDR, MHD, HMDe, HMDn, Mallampati score and Body Mass Index (BMI). The cut-off points for the DI predictors were: HMDe<5.3 cm, HMDn≤5.5 cm, MHD<2.0cm, MHD>3.5cm and HMDR≤1.2. The basic criteria that were observed were as follows: frequency of difficult visualisation of the larynx and DEI. The assessment that DEI existed was made by the anaesthesiologist while doing laryngoscopy by applying the Cormack-Lehane classification. Results: Difficult intubation was present in 13 patients (5 %). As for the frequency of DEI no considerable statistical difference was recorded concerning the sex, age and BMI of the patients. Also, concerning HMDn and MHD no considerable difference was recorded between the groups with and without DEI, while as for the Mallampati score, HMDe and HMDR a considerable statistical difference was recorded...