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LETTER TO THE EDITOR

Identifying and Evaluating Predictors of a Difficult Airway: The Importance of Not Excluding the Really Interesting Patients

Anaesthesia and Operating Theatre Services; Center of Head and Orthopaedics; Rigshospitalet; University Hospital of Copenhagen; Copenhagen, Denmark; msk{at}rh.dk

To the Editor:

In the very interesting study by Cattano et al. (1) one important methodological aspect seems to have been overlooked.

"Those requiring...an awake intubation were excluded from the study."

It is likely that "those requiring an awake intubation" comprises the patients who were judged to be at the highest risk of presenting a difficult airway. As the whole purpose of performing a pre-anesthetic airway examination is to identify the patients with a difficult airway, it seems contradictory to exclude exactly the patients that you most want to identify!

The same problem was present in a previous, otherwise excellent, very large study (including >10000 patients) (2) in which approximately 50 patients were intubated awake, thus not entering the study at all (Dr. ElGanzouri, personal communication).

How many patients had an awake intubation in the present study (1)? And why were they scheduled for awake intubation? Were they pre-anesthetically identified by the same variables as those investigated in the study?

Exclusion of the true difficult patients from studies like this will result in falsely low reported rates of difficult airway and probably in falsely low positive predictive values of the indicators of a difficult airway in the population presenting for surgery.

References

1. Cattano D, Panicucci E, Paolicchi A, et al. Risk factors assessment of the difficult airway: an Italian survey of 1956 patients. Anesth Analg 2004;99:1774–9.[Abstract/Free Full Text]
2. El-Ganzouri AR, McCarthy RJ, Tuman KJ, et al. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg 1997;84:419–21.[Abstract]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kristensen, M. S. Search for Related Content PubMed PubMed Citation Articles by Kristensen, M. S.