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ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH

Risk Factors Assessment of the Difficult Airway: An Italian Survey of 1956 Patients

D. Cattano, MD^*, E. Panicucci, StD, A. Paolicchi, MD^*, F. Forfori, MD^*, F. Giunta, MD^*, and C. Hagberg, MD

*Department of Surgery, Anaesthesia and Intensive Care Division, Spedali Riuniti S. Chiara, University of Pisa, Pisa, Italy; Department of Human and Environmental Sciences, University of Pisa, Pisa, Italy; and Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas

Address correspondence and reprint requests to Davide Cattano, MD, via dell’Isola 79, 55010 Lunata Lucca, Italy. Address e-mail to davidecattano{at}hotmail.com

Over the last decade, there has been a heightened awareness and an increase in the amount of literature being published on recognition and prediction of the difficult airway. During the preoperative evaluation of the airway, a thorough history and physical specifically related to the airway should be performed. Various measurements of anatomic features and noninvasive clinical tests can be performed to enhance this assessment. In this study we correlated the Mallampati modified score and several other indexes with the laryngoscopic view to identify anatomical and clinical risk factors related to the difficult airway. We prospectively collected data on 1956 consecutive patients scheduled to receive general anesthesia requiring endotracheal intubation for elective surgery. The Mallampati classification versus the Cormack-Lehane (C-L) linear correlation index was 0.904. A Mallampati Class 3 correlated with a C-L Grade 2 (0.94), whereas a Mallampati Class 4 correlated with a C-L Grade 3 (0.85) and a C-L Grade 4 (0.80). Operator evaluation, performed by a simplified tracheal intubation difficulty scale, showed a linear correlation of 0.96 compared with the C-L groups. Although there is a correlation between oropharyngeal volume and difficult intubation, the Mallampati score by itself is insufficient for predicting difficult endotracheal intubation.

IMPLICATIONS: We collected data to correlate anatomical indexes and the difficult airway. The Mallampati score correlates with the laryngoscopic view (Cormack-Lehane score), but it is not useful in the prediction of difficult intubation as a single risk factor.

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