2019, Number 2
<< Back Next >>
Revista Cubana de Anestesiología y Reanimación 2019; 18 (2)
El-Ganzouri index effectiveness for predicting the degree difficulty in tracheal intubation
Fernández PC, Cordero EI, Mora DI
Language: Spanish
References: 37
Page: 1-19
PDF size: 215.88 Kb.
ABSTRACT
Introduction: Difficult airway Intubation is a health problem. To prevent it, different
rate values have been used.
Objective: To evaluate the usefulness of El-Ganzouri index for predicting the degree
of difficulty in tracheal intubation by conventional laryngoscopy.
Method: A descriptive, cross-sectional study was carried out with patients who
needed tracheal intubation, in Hermanos Ameijeiras Hospital, between February 2014
and 2017. This test combines and stratifies seven variables derived from individually
associated observational parameters. Their values were stratified and interpreted
(below 4, easy airway; 4 or higher, difficult airway).
Results: We studied 94 patients, in which the El-Ganzouri index was evaluated. The
age group of 50-59 years (29.8%) and the male sex (52.1%) predominated. ASA II
was more frequent, accounting for 66%. The El Ganzouri index prevailed the oral
opening over 4 cm, the tiromentonian distance below 6.5 cm, the Mallamapati class
was present in 91.5%, neck movements below 90°, body weight over 90 kg, and no
antecedent of history of difficult intubation in 67.0%. Upon corroborating the
predictive tests with that of Cormack and Lehane, it was observed that 92.6% of the
patients had an easy airway and this condition was obtained in 78.7% with the El
Ganzouri index. Sensitivity was 71.43% and specificity was 20.69%. The positive
predictive value was 6.76, and the negative predictive value was 90.0.
Conclusions: The usefulness of the multivariate El-Ganzouri risk index was confirmed
for the prediction of the degree of difficulty in tracheal intubation by conventional
laryngoscopy. Sensitivity, specificity, positive and negative predictive values were
identified, which showed good prediction of anatomically difficult airway.
REFERENCES
Caldiroli D, Cortellazzi P. A new difficult airway management algorithm based upon the El Ganzouri Risk Index and GlideScope® videolaryngoscope: a new look for intubation? Minerva Anestesiol. 2011;77(10):1011-7.
Theiler L, Fischer H, Voelke N, Basciani R, Hasty F, Greif R. Survey on controversies in airway management among anesthesiologists in the UK, Austria and Switzerland. Minerva Anestesiologica. 2012;78(10):1088-94.
El-Ganzouri AR, McCarthy RJ, Pharm D, Tuman K, Tanck EN, Ivankovich AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth & Analg. 1996;82(6):1197-1204.
Teoh WH, Kristensen MS. Prediction in airway management: what is worthwhile, what is a waste of time and what about the future? Br J Anaesth. 2016;117(1):1-3.
Gupta S, Pareek S, Dulara SC. Comparison of two methods for predicting difficult intubation in obstetric patients0"Middle East J Anesthesiol."2003=17<275/85.
Mathur R, Jain PK, Chakotiya PS, Rathore P. Anaesthetic and airway management of a post-burn contracture neck patient with microstomia and distorted nasal anatomy. Indian J Anaesth. 2014;58(3):349.
Nørskov AK, Lundstrøm LH, Rosenstock CV, Wetterslev J. Detailed statistical analysis plan for the difficult airway management (DIFFICAIR) trial. Trials. 2014;15:173.
Duke J. Manejo de la vía aérea. En: Anestesia secretos. Cuarta edición. Barcelona: Elsevier Mosby; 2011. p. 58-67.
Roewer N, Thiel H. Vía aérea artificial. En: Anestesia texto y atlas. Cuarta edición. Madrid: Panamericana: 2011. p 106-21.
Urman R. Control de las vías respiratorias. En: Anestesia de bolsillo. Primera edición. Madrid: Wolters Kluwer Health; 2011. p. 126-38.
Salguero Arispe EE, Torres Salazar JT. Signos predictores y su correlación con la intubación. Gaceta Médica Boliviana 2008 [citado 15/03/2011]. Disponible en: http://www.scielo.org.bo/scielo.php?script=sci_arttext&pid=S1012-29662008000100007
Orozco Díaz E, Álvarez Ríos JJ, Arceo Díaz JL, Ornelas Aguirre JM. Predicción de intubación difícil mediante escalas de valoración de la vía aérea. Cir. 2010;78:393-99.
Pérez Santos FJ, Hernández Salgado M, Díaz-Landeira H, Santana Domínguez M, Domínguez García J, Herrera García M. Efectividad del uso de predictores de vía aérea difícil en el área de urgencias. Emergencias. 2011;23:293-98.
Vallongo Menéndez MB, Fernández Abreu S, Cordoví de Armas L. Predictores e indicadores de via aérea difícil según diferentes índices de masa corporal. Acta Peru Anestesiol. 2011;19:91-96.
Valero A, Mayoral V, Massó E, López A, Sabaté S, Villango A, et al. Evaluación y manejo de la vía aérea difícil prevista y no prevista: Adopción de guías de práctica. Rev Español Anestesiol Reanm. 2008;55 (9):563-70.
Palomera Flores G, Peraza Olivas J. Determinación del grado de predicción de intubación difícil en pacientes obesos. Rev Anestesia en México. 2006 [citado 08/2012];18(2). Disponible en: http://www.fmca.org.mx/art/art.php?id=668
Law JA, Broemling N, Cooper RM, Drolet P, Duggan LV, Griesdale DE, et al. The difficult airway with recommendations for management. Part 1. Difficult tracheal intubation encountered in an unconscious/induced patient. Can J Anaesth. 2013;60(11):1089-118.
Sakles JC, Chiu S, Mosier J, Walker C, Stolz U. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med. 2013;20:71-78.
Hasegawa K, Shigemitsu K, Hagiwara Y. Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study. Ann Emerg Med. 2012;60:749-54.
Martin LD, Mhyre JM, Shanks AM, Tremper KK, Kheterpal S. 3 423 emergency tracheal intubations at a university hospital: airway outcomes and complications. Anesthesiology. 2011;114:42-48.
Cook T, Woodall N, Frerk C. 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617-31.
Cooper RM. A Comparison of the Mallampati evaluation in neutral or extended cervical spine positions: a retrospective observational study of 80 000 patients. BJA. 2016;116(5):690-98.
Fuentes Díaz Z, Salazar Diez M. Consideraciones de los modelos pronósticos en la evaluación del preoperatorio del paciente electivo no cardiaco. Rev Cubana Anestesiol Reanim. 2015 [citado 05/2016];14(1). Disponible en: http://bvs.sld.cu/revistas/scar/vol14_2_15/scar07215.htm
Apfelbaum JL, Hagberg CA, Caplan RA. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251-270.
Aziz MF, Healy D, Kheterpal S, Fu RF, Dillman D, Brambrink AM. Routine clinical practice effectiveness of the Glidescope in difficult airway management: an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions. Anesthesiology. 2011;114:34-41.
Hung O, Murphy M. Context-sensitive airway management. Anesth Analg. 2010;110:982-3.
Ramachandran SK, Cosnowski A, Shanks A, Turner CR. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of nasal oxygen administration. J Clin Anesth. 2010;22:164-68.
Patel A, Pearce A, Pracy P. Head and neck pathology. In: Cook T, Woodall N, Frerk C (Eds). 4th National Audit Project of the Royal College of Anaesthetists and The Difficult Airway Society. Major Complications of Airway Management in the United Kingdom. London: The Royal College of Anaesthetists; 2011:143-54.
Cullen A, Ferguson A. Perioperative management of the severely obese patient: a selective pathophysiological review. Can J Anesth. 2012;59:974-96.
Pandit JJ, Popat MT, Cook TM, Wilkes AR, Groom P, Cooke H, et al. The Difficult Airway Society ‘ADEPT’ guidance on selecting airway devices: the basis of a strategy for equipment evaluation. Anaesthesia. 2011;66(8):726-37.
Grünberg G, Bounous A, Prestes I, Guzmán A, Illescas L, Ferreira E, et al. Evaluación de los métodos predictores de vía aérea dificultosa en pacientes coordinados para procedimientos endoscópicos de vía aérea superior. Anest Analg Reanim. 2006 [citado 15/02/2017];21(1). Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-12732006000100003
Kahan BC, Morris TPT. Reporting and analysis of trials using stratified randomisation in leading medical journals: review and reanalysis. BMJ Br Med J. 2012;345:5840-10.
Lundstrøm LH. Detection of risk factors for difficult tracheal intubation. Dan Med J. 2012,59(4):4431.
Corso RM, Cattano D, Buccioli M, Carretta E, Maitan S. Post analysis simulated correlation of the El-Ganzouri airway difficulty score with difficult airway. Rev. Bras. Anestesiol. 2016 [citado 15/02/2017];66(3). Disponible en: http://dx.doi.org/10.1016/j.bjane.2014.09.003
Amores Agulla T. Valor predictivo del sistema de evaluación El-Ganzouri para diagnóstico de vía aérea difícil. Rev cubana Anest Rean. 2013 [citado 12/2016]. Disponible en: http://www.scar2013.sld.cu/index.php/anestesiologia/2013/paper/view47
Woodall NM, Cook TM. National census of airway management techiniques used for anaesthesia in UK: first phase of foourth national audit project at the royal college of anaesthesist. Br. J Aneçaesth. 2008;11(106):266-71.
Kheterpal S, Han R, Tremper KK, Shanks AM, Tait AR, O’Reilly M, et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006,105:885-91.