Review of a systematic approach for suspected difficult intubation under general anaesthesia
Notice bibliographique
Résumé
We routinely use the Glidescope (GS) in patients with suspected difficult airways. However, failure to use a standard Macintosh (Mac) blade prevents confirmation of difficult laryngoscopy and causes probable overuse of an expensive videolaryngoscope. Since the McCoy blade has a Mac profile in the neutral position, by first using the McCoy, one can confirm the clinical suspicion and if necessary trial the alternative blade profile, all during a single direct laryngoscopy. Our aims were to provide vital airway information that is missed if only the GS is used, to reduce the use of the GS where not needed, and to compare McCoy and GS laryngoscopic views. After ethics approval, we audited a systematic approach to difficult intubation using the McCoy blade, followed by the GS if the initial Mac and McCoy views were inadequate. Data were analysed from an anonymous quality assurance form on which airway characteristics and laryngoscopic grades had been recorded by the attending anaesthesiologist. A laryngeal grade ≥ 3 was considered to be difficult. In 61 patients predicted to have a difficult intubation, the Mac view confirmed the clinical suspicion in 42 (69%), of which there were four cases of grade 4 and 38 cases of grade 3 views. The McCoy converted 4/4 Mac grade 4 views to grade 3 and 27/38 (70%) Mac grade 3 views to grade < 3. The GS converted all of the residual McCoy grade 3 views (4 + 11) to intubatable views. There were no failed or fibreoptic intubations. In 34 patients, the anaesthetist decided to complete all three laryngoscope views. The Mac view was difficult (grade ≥ 3) in 28 (82%), the McCoy view was difficult in 14 (41%) and the GS view was difficult in none (see Table). Analysis using McNemar chi-squared test showed the difference between McCoy and GS views to be highly significant. By first achieving a Mac view, 19/61 (31%) of suspected difficult intubations were found to be intubatable. The McCoy blade is a simple portable device that successfully changed a difficult grade 3 view into a manageable one in 70% of cases. However, the GS appears to be a superior tool in that it converted 29/29 (100%) of grade 3 and 4 Mac views into intubatable views. It must be remembered that a good GS view does not necessarily mean an easy intubation. Costs aside, we must be careful not to overuse our videolaryngoscopes as this could lead to a skill fade in direct laryngoscopy. We feel that videolaryngoscopy should be emphasised in the DAS guidelines. A randomised controlled trial is required to confirm these promising results. Using a systematic approach to suspected difficult intubation under GA, we found the McCoy blade to be valuable. The Glidescope however gave far superior laryngoscopic exposure converting all grade 3 and 4 Macintosh views into intubatable views.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,026 | 0,176 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,002 |
| Méta-épidémiologie (sens large) | 0,006 | 0,005 |
| Bibliométrie | 0,036 | 0,022 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,003 | 0,004 |
| Science ouverte | 0,003 | 0,003 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».