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The best method to predict easy intubation: a quasi-experimental pilot study
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences. Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden; Department of Public Health and Caring Sciences, Section for Caring Sciences, Uppsala University, Uppsala, Sweden.
2014 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 29, no 4, 292-297 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

To facilitate evaluation of the airway before endotracheal intubation, different scores have been developed, mainly to predict difficult airways. However, in anesthesia clinical practice in Sweden, scores would be more useful if they could also predict an easy airway, so that the correct category of anesthesia personnel can be allocated. Therefore, we evaluated whether scoring systems commonly used to predict difficult airways could also predict easy endotracheal intubation.

DESIGN:

This prospective observational study included patients who were scheduled for general anesthesia and required endotracheal intubation.

METHODS:

Airways were evaluated preoperatively by two independent variables, namely Mallampati classification and thyromental distance. After anesthesia induction, the Cormack and Lehane grade was assessed.

FINDING:

Mallampati scores yielded the highest specificity in predicting easy intubation, and Cormack and Lehane grades yielded the highest positive predictive value for predicting easy intubation.

CONCLUSIONS:

Mallampati classification is an appropriate screening test for predicting easy intubation.

Place, publisher, year, edition, pages
2014. Vol. 29, no 4, 292-297 p.
Keyword [en]
intubation, Mallampati classification, Cormack and Lehane grade, airway management
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hig:diva-17345DOI: 10.1016/j.jopan.2013.05.015ISI: 000340344000005PubMedID: 25062573Scopus ID: 2-s2.0-84904664939OAI: oai:DiVA.org:hig-17345DiVA: diva2:737492
Projects
Patientsäkerhet och omvårdnad i samband med anestesi med fokus på luftvägen
Available from: 2014-08-13 Created: 2014-08-13 Last updated: 2016-04-29Bibliographically approved
In thesis
1. Airway management in anaesthesia care: professional and patient perspectives
Open this publication in new window or tab >>Airway management in anaesthesia care: professional and patient perspectives
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Careful airway management, including tracheal intubation, is important when performing anaesthesia in order to achieve safe tracheal intubation. Aim: To study airway management in anaesthesia care from both the professional and patient perspectives. Methods: 11 RNAs performed three airway tests in 87 patients, monitored in a study-specific questionnaire. The tests usefulness for predicting an easy intubation was analysed (Study I). 68 of 74 anaesthesia departments in Sweden answered a self-reported questionnaire about the presence of airway guidelines (Study II). 20 anaesthesiologists were interviewed; a phenomenographic analysis was performed to describe how anaesthesiologists' understand algorithms for management of the difficult airway (Study III). 13 patients were interviewed; content analysis was performed to describe patients' experiences of being awake fiberoptic intubated (Study IV). Results: The Mallampati classification is a good screening test for predicting easy intubation and intubation can be safely performed by RNAs (Study I). The presence of airway guidelines in Swedish anaesthesia departments is poorly implemented (Study II). Algorithms can be understood as law-like rules, a succinct plan to follow in difficult airway situations, an action plan kept in the back of one's mind while creating flexible and versatile personal algorithms, or as consensus guidelines based on expert opinion in order to be followed in clinical practice (Study III). One theme emerged describing experiences of being awake intubated; feelings of being in a vulnerable situation but cared for in safe hands, described in five categories: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff's competence, professional caring and support, and no hesitation about new awake intubation (Study IV). Conclusions: The Mallampati classification is a good screening test for predicting easy intubation, when the airway assessment is performed in a structured manner by RNAs. The presence of airway guidelines in Swedish anaesthesia departments was poorly implemented and should receive higher priority. Algorithms need to be simple and easy to follow and based on the best available scientific evidence. Tailored information about what to expect, ensuring eye contact, and giving breathing instructions during the procedure may reduce patients' feeling distress.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 56 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1205
Keyword
Airway management, algorithm, awake intubation, professional and patient perspective
National Category
Nursing Anesthesiology and Intensive Care
Research subject
Medical Science
Identifiers
urn:nbn:se:hig:diva-21451 (URN)978-91-554-9534-3 (ISBN)
Public defence
2016-05-20, Brömssalen, Gävle sjukhus, Lasarettsvägen 1, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2016-04-29Bibliographically approved

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Citation style
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