Addition of flexible laryngoscopy to anesthesiological parameters improves prediction of difficult intubation in laryngeal surgery

Danica Marković; Maja Šurbatović; Dušan Milisavljević; Vesna Marjanović; Toma Kovačević; Milan Stanković

doi:10.5114/ait.2024.146728

eISSN: 1731-2531
ISSN: 1642-5758

Anaesthesiology Intensive Therapy

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abstract:

Original article

Addition of flexible laryngoscopy to anesthesiological parameters improves prediction of difficult intubation in laryngeal surgery

Danica Marković

¹

,

Maja Šurbatović

^{2, 3}

,

Dušan Milisavljević

^{4, 5}

,

Vesna Marjanović

^{1, 6}

,

Toma Kovačević

⁴

,

Milan Stanković

^{4, 5}

Clinic for Anesthesiology and Intensive Therapy, University Clinical Center in Niš, Niš, Serbia
Clinic for Anesthesiology and Intensive Therapy, Military Medical Academy, Belgrade, Serbia
Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Otolaryngology Clinic, University Clinical Center in Niš, Niš, Serbia
Department Otorhinolaryngology, Faculty of Medicine, University in Niš, Niš, Serbia
Department of Surgery and Anesthesiology and Reanimatology, Faculty of Medicine, University in Niš, Niš, Serbia

Anaesthesiol Intensive Ther 2024; 56, 5: 295–304

DOI: https://doi.org/10.5114/ait.2024.146728

Online publish date: 2025/01/17

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AMA

Marković D, Šurbatović M, Milisavljević D, Marjanović V, Kovačević T, Stanković M. Addition of flexible laryngoscopy to anesthesiological parameters improves prediction of difficult intubation in laryngeal surgery. Anaesthesiology Intensive Therapy. 2024;56(5):295-304. doi:10.5114/ait.2024.146728.

APA

Marković, D., Šurbatović, M., Milisavljević, D., Marjanović, V., Kovačević, T.,  & Stanković, M. (2024). Addition of flexible laryngoscopy to anesthesiological parameters improves prediction of difficult intubation in laryngeal surgery. Anaesthesiology Intensive Therapy, 56(5), 295-304. https://doi.org/10.5114/ait.2024.146728

Chicago

Marković, Danica, Maja Šurbatović, Dušan Milisavljević, Vesna Marjanović, Toma Kovačević,  and Milan Stanković. 2024. "Addition of flexible laryngoscopy to anesthesiological parameters improves prediction of difficult intubation in laryngeal surgery". Anaesthesiology Intensive Therapy 56 (5): 295-304. doi:10.5114/ait.2024.146728.

Harvard

Marković, D., Šurbatović, M., Milisavljević, D., Marjanović, V., Kovačević, T.,  and Stanković, M. (2024). Addition of flexible laryngoscopy to anesthesiological parameters improves prediction of difficult intubation in laryngeal surgery. Anaesthesiology Intensive Therapy, 56(5), pp.295-304. https://doi.org/10.5114/ait.2024.146728

MLA

Marković, Danica et al. "Addition of flexible laryngoscopy to anesthesiological parameters improves prediction of difficult intubation in laryngeal surgery." Anaesthesiology Intensive Therapy, vol. 56, no. 5, 2024, pp. 295-304. doi:10.5114/ait.2024.146728.

Vancouver

Marković D, Šurbatović M, Milisavljević D, Marjanović V, Kovačević T, Stanković M. Addition of flexible laryngoscopy to anesthesiological parameters improves prediction of difficult intubation in laryngeal surgery. Anaesthesiology Intensive Therapy. 2024;56(5):295-304. doi:10.5114/ait.2024.146728.

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Introduction:
Among the numerous scores for difficult intubation assessment, there is no single score that is specific for laryngeal surgery. The parameters identified by this research will provide a foundation for developing a new score for preoperative airway assessment specific for laryngeal surgery.

Material and methods:
This prospective pilot clinical study included 50 patients over 18 scheduled for microscopic laryngeal surgery. The following anesthesiological and surgical parameters were analyzed: flexible laryngoscopy, general and clinical data, inter-incisor gap (IIG), modified Mallampati score (MMP), S-lux, thyromental distance, sternomental distance, mandibular measurements, etc. Difficult intubation was defined according to the Intubation Difficulty Scale (IDS), and the patients were divided into difficult (DI) and normal (NI) intubation.

Results:
According to the IDS scale, 17 (34%) intubations were characterized as difficult. Patients in the DI group were male (P = 0.033) and had apnea during sleep (P = 0.021). Other statistically significant parameters were IIG below 4 cm, reclination, neck girth, and MMP. Flexible laryngoscopy showed a high statistical significance of P = 0.0001. These parameters have an AUC of 0.955, with χ² = 43.268, P < 0.0001.

Conclusions:
The combination of the statistically significant parameters shows excellent accuracy in laryngeal surgery. This combination can form a basis to develop a preoperative airway assessment score specific to laryngeal surgery.

keywords:

Addition of flexible laryngoscopy to anesthesiological parameters improves prediction of difficult intubation in laryngeal surgery

Danica Marković 1 , Maja Šurbatović 2, 3 , Dušan Milisavljević 4, 5 , Vesna Marjanović 1, 6 , Toma Kovačević 4 , Milan Stanković 4, 5

laryngoscopy, airway management, intratracheal intubation, airway assessment, intubation, difficult

Danica Marković

¹

,

Maja Šurbatović

^{2, 3}

,

Dušan Milisavljević

^{4, 5}

,

Vesna Marjanović

^{1, 6}

,

Toma Kovačević

⁴

,

Milan Stanković

^{4, 5}