Sternomental displacement and neck circumference: a new look for the neck as a difficult airway predictor in obese surgical patients—a cohort study
Abstract Background Sternomental displacement (SMDD) is a surrogate indicator for cervical spine (C-spine) mobility. SMDD revealed good potential to predict difficult airway, but its validity in obese patients is not evident. Therefore, this study assessed the performance of SMDD with neck circumfer...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-08-01
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| Series: | Ain Shams Journal of Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s42077-023-00355-1 |
| _version_ | 1797743972590813184 |
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| author | Antony Gorgy Abeer Ahmed Mohamed Atef Nevan Mekawy Wael Sami Heba Nagy |
| author_facet | Antony Gorgy Abeer Ahmed Mohamed Atef Nevan Mekawy Wael Sami Heba Nagy |
| author_sort | Antony Gorgy |
| collection | DOAJ |
| description | Abstract Background Sternomental displacement (SMDD) is a surrogate indicator for cervical spine (C-spine) mobility. SMDD revealed good potential to predict difficult airway, but its validity in obese patients is not evident. Therefore, this study assessed the performance of SMDD with neck circumference (NC) in predicting difficult airway in obese surgical patients. The study involved 135 adult patients with body mass index (BMI) ≥ 35 kg/m2 scheduled for elective surgeries under general anesthesia with endotracheal tubes (ETT) inserted using Macintosh laryngoscopes. The airway was assessed using SMDD, NC, and modified Mallampati test (MMT). Difficult laryngoscopy view (DLV) was defined as Cormack–Lehane (C-L) grade ≥ 3. The accuracy of the SMDD in predicting DLV was set as the primary endpoint, while the accuracy of the SMDD compared to that of NC, MMT, and NC/SMDD ratio in predicting difficult airway was set as the secondary endpoint. Results The DLV cases were 28 of 135 (20.7%), with a mean BMI of 41.1 ± 3.3 kg/m2. SMDD < 5cm and NC > 43 cm could predict DLV with an area under the receiver operating characteristic curve (AUROC) of 0.97 and 0.83 respectively. SMDD and NC had a good negative correlation (r = − 0.6; 95% CI = 0.7 to 0.4; p = 0.0001). The NC/SMDD ratio had the best prediction for DLV (AUROC of 0.98 at a cut-off value > 7.8). Conclusions In obese surgical patients, SMDD and NC/SMDD ratios are excellent predictors for DLV when the cut-off values are < 5cm and > 7.8, respectively. Trial registration ClinicalTrials.gov, NCT04524546. Registered in August 2020. |
| first_indexed | 2024-03-12T15:03:11Z |
| format | Article |
| id | doaj.art-260f1e42088c4858a80aafef44e22ae9 |
| institution | Directory Open Access Journal |
| issn | 2090-925X |
| language | English |
| last_indexed | 2024-03-12T15:03:11Z |
| publishDate | 2023-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Ain Shams Journal of Anesthesiology |
| spelling | doaj.art-260f1e42088c4858a80aafef44e22ae92023-08-13T11:05:48ZengSpringerOpenAin Shams Journal of Anesthesiology2090-925X2023-08-011511810.1186/s42077-023-00355-1Sternomental displacement and neck circumference: a new look for the neck as a difficult airway predictor in obese surgical patients—a cohort studyAntony Gorgy0Abeer Ahmed1Mohamed Atef2Nevan Mekawy3Wael Sami4Heba Nagy5Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo UniversityDepartment of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo UniversityDepartment of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo UniversityDepartment of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo UniversityDepartment of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo UniversityDepartment of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo UniversityAbstract Background Sternomental displacement (SMDD) is a surrogate indicator for cervical spine (C-spine) mobility. SMDD revealed good potential to predict difficult airway, but its validity in obese patients is not evident. Therefore, this study assessed the performance of SMDD with neck circumference (NC) in predicting difficult airway in obese surgical patients. The study involved 135 adult patients with body mass index (BMI) ≥ 35 kg/m2 scheduled for elective surgeries under general anesthesia with endotracheal tubes (ETT) inserted using Macintosh laryngoscopes. The airway was assessed using SMDD, NC, and modified Mallampati test (MMT). Difficult laryngoscopy view (DLV) was defined as Cormack–Lehane (C-L) grade ≥ 3. The accuracy of the SMDD in predicting DLV was set as the primary endpoint, while the accuracy of the SMDD compared to that of NC, MMT, and NC/SMDD ratio in predicting difficult airway was set as the secondary endpoint. Results The DLV cases were 28 of 135 (20.7%), with a mean BMI of 41.1 ± 3.3 kg/m2. SMDD < 5cm and NC > 43 cm could predict DLV with an area under the receiver operating characteristic curve (AUROC) of 0.97 and 0.83 respectively. SMDD and NC had a good negative correlation (r = − 0.6; 95% CI = 0.7 to 0.4; p = 0.0001). The NC/SMDD ratio had the best prediction for DLV (AUROC of 0.98 at a cut-off value > 7.8). Conclusions In obese surgical patients, SMDD and NC/SMDD ratios are excellent predictors for DLV when the cut-off values are < 5cm and > 7.8, respectively. Trial registration ClinicalTrials.gov, NCT04524546. Registered in August 2020.https://doi.org/10.1186/s42077-023-00355-1Difficult laryngoscopyDifficult intubationSternomental displacementNeck circumferenceObesity |
| spellingShingle | Antony Gorgy Abeer Ahmed Mohamed Atef Nevan Mekawy Wael Sami Heba Nagy Sternomental displacement and neck circumference: a new look for the neck as a difficult airway predictor in obese surgical patients—a cohort study Ain Shams Journal of Anesthesiology Difficult laryngoscopy Difficult intubation Sternomental displacement Neck circumference Obesity |
| title | Sternomental displacement and neck circumference: a new look for the neck as a difficult airway predictor in obese surgical patients—a cohort study |
| title_full | Sternomental displacement and neck circumference: a new look for the neck as a difficult airway predictor in obese surgical patients—a cohort study |
| title_fullStr | Sternomental displacement and neck circumference: a new look for the neck as a difficult airway predictor in obese surgical patients—a cohort study |
| title_full_unstemmed | Sternomental displacement and neck circumference: a new look for the neck as a difficult airway predictor in obese surgical patients—a cohort study |
| title_short | Sternomental displacement and neck circumference: a new look for the neck as a difficult airway predictor in obese surgical patients—a cohort study |
| title_sort | sternomental displacement and neck circumference a new look for the neck as a difficult airway predictor in obese surgical patients a cohort study |
| topic | Difficult laryngoscopy Difficult intubation Sternomental displacement Neck circumference Obesity |
| url | https://doi.org/10.1186/s42077-023-00355-1 |
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