Difficult Airway
Conditions
Brief summary
Based on the evaluation of preoperative physical indicators and radiologic indicators of cervical surgery, this study puts forward effective indicators for predicting difficult airway before operation, and establishes a comprehensive decision support system of difficult airway evaluation, so as to provide a theoretical basis for the early warning of difficult airway before cervical spondylosis surgery.
Detailed description
In the past, the evaluation of difficult airway mainly depended on physical indicators, but the internal structure of airway could not be found by appearance inspection. Therefore, unexpected emergency airway often appeared in clinical work, which seriously affected medical safety. In this study, the specific mechanism of difficult laryngoscopy in patients undergoing cervical spondylosis surgery is clarified by the combination of the physical indicators and radiologic indicators. On this basis, we will establish the preoperative airway evaluation system for cervical spondylosis surgery, optimize the standardized process of preoperative airway evaluation, and accurately screen out high-risk patients.
Interventions
PROCEDUREendotracheal intubation
all patients will receive laryngoscopy and endotracheal intubation
Sponsors
Peking University Third Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Inclusion criteria
* patients of ASA I-III * scheduled for elective surgery for cervical spondylosis under general anesthesia with tracheal intubation
Exclusion criteria
* patients with cervical spine instability * oropharyngeal mass * airway disease * preoperative imaging data were incomplete * refuse to sign informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cormack-Lehane (CL) classification | During induction | describe laryngeal view during direct laryngoscopy |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| X6(X-ray indicators) | During review the X-ray image | atlanto-occipital gapantero-superior border of the first cervical vertebra |
| W (CT/MRI indicators) | During review the CT/MRI image | the maximal width of the tongue base |
| MRI1 (MRI indicators) | During review the CT/MRI image | distance between the base of the tongue and the posterior pharyngeal wall |
| MRI4 (MRI indicators) | During review the CT/MRI image | distance between the vocal cords and the posterior pharyngeal wall |
| MRI5 (MRI indicators) | During review the CT/MRI image | length of the epiglottis |
| MRI2 (MRI indicators) | During review the CT/MRI image | distance between the epiglottis and the posterior pharyngeal wall |
| MRI3 (MRI indicators) | During review the CT/MRI image | distance between the uvula and the posterior pharyngeal wall |
| V (CT/MRI indicators) | During review the CT/MRI image | volume of the tongue base |
| Rs (CT/MRI indicators) | During review the CT/MRI image | Rs= S/( Hp-h\* Dt-p); Rv =V/( Hp-h\* Dt-p\*W) |
| X1(X-ray indicators) | During review the X-ray image | distance between the temporomandibular joint and tip of the upper incisors |
| X2(X-ray indicators) | During review the X-ray image | perpendicular distance from the hard palate to the tip of the upper incisors |
| X3(X-ray indicators) | During review the X-ray image | length of the mandibular body |
| X4(X-ray indicators) | During review the X-ray image | vertical distance from the highest point of the hyoid bone to the mandibular body |
| X5(X-ray indicators) | During review the X-ray image | distance from the antero-inferior border of the fourth cervical vertebra to the antero-superior border of the first cervical vertebra |
| X7(X-ray indicators) | During review the X-ray image | horizontal distance from the highest point of the hyoid bone to the border of the nearest cervical vertebra |
| X8(X-ray indicators) | During review the X-ray image | distance between the spinous processes of the first cervical vertebra and the second cervical vertebra |
| A1 (X-ray indicators) | During review the X-ray image | the angle between a line passing through the bottom of second cervical vertebra and a line passing through the bottom of sixth cervical vertebra in the neutral/ extension position |
| Hp-h (CT/MRI indicators) | During review the CT/MRI image | the distance from back end of the hard palate to the top of hyoid |
| Ht (CT/MRI indicators) | During review the CT/MRI image | the height of the tongue base, along Hp-h from the tongue to the top of hyoid |
| Dt-p (CT/MRI indicators) | During review the CT/MRI image | the distance from the back end of tongue to posterior pharyngeal wall |
| Dt (CT/MRI indicators) | During review the CT/MRI image | the distance from the back end of tongue to Hp-h |
| S (CT/MRI indicators) | During review the CT/MRI image | the central sectional area of the tongue base behind Hp-h |
Other
| Measure | Time frame | Description |
|---|---|---|
| neck circumference, | measurement one day before operation] | physical indicator |
| modified Mallampati test, | measurement one day before operation] | physical indicator |
| thyromental distance | measurement one day before operation] | physical indicator |
| inter-incisor gap | measurement one day before operation] | physical indicator |
Countries
China
Contacts
Primary ContactYongzheng Han, M.D.
Outcome results
None listed