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Research Article | Volume 14 Issue 5 (Sept - Oct, 2024) | Pages 415 - 426
An Observational Study on The Airway assessment and Causes of Difficult Endotracheal Intubation During Preanesthetic Checkup Clinic in Different Age Groups
 ,
 ,
1
post Graduate, Department of Anesthesiology, Chettinad Academy of Research and Education Kelambakkam, Tamil Nadu -603103 India
2
Professor, Department of Anaesthesiology, Chettinad Academy of Research and Education Kelambakkam, Tamil Nadu -603103, India
3
B.sc allied health sciences student Chettinad Academy of Research and Education Kelambakkam, Tamil Nadu -603103, India
Under a Creative Commons license
Open Access
Received
July 30, 2024
Revised
Aug. 31, 2024
Accepted
Sept. 10, 2024
Published
Oct. 5, 2024
Abstract

Background And Justifications: Pre-anesthetic checkup is a necessary tool to take the detailed history of the patient, conduct physical examination and investigations which is used to evaluate the peri-operative risk informing priorly about the surgical anesthetic complications and risk factors As aging causes decline in the progressive function of the organ system, it is important to detect the underlying diseases, dental loss,head and neck joint changes ,so it is very important to plan for the level of difficulty in the endotracheal intubation,as the delay in endotracheal intubation can causes fatal consequences. The current study is carried out to determine the causes of difficult endotracheal intubation in the patients of different age groups and to assess the airway. Objectives: The objective of the study is to assess the airway and difficulty of endotracheal intubation during pre-anaesthetic checkup in different age groups. Results: The total of 60 patients included in the study,29(43.30%) were male and 31(51.66%) were female.To assess predictive factor for endotracheal intubation according to the three age groups.Patients basic demographic profiles assessed according to the Wilson’s scoring of airway assessment was investigated.In this study 56 (93.33%) patients experienced easy intubation, 3(5%)patients were experienced moderate difficulty and 1(1.66%) patient experienced difficult tracheal intubation(P=0.21192) Conclusion: The study’s findings shows that the age is not a factor for difficult endotracheal intubation and its predictive factors are varying by different age groups..

Keywords
INTRODUCTION

The peri-operative care of a surgical patient includes preoperative evaluation (to determine the patient's capacity to withstand the procedure). During the time of the history-taking and examination, the surgeon is where it all starts. Pre-anesthesia evaluation (PAE) or pre-anesthesia check (PAC) are two terms commonly used to describe the procedure performed by anesthesiologists. For both surgical and nonsurgical procedures, PAC typically comes first [1]. The main goal of this endeavour is to evaluate and diagnose co-morbidities that may have an impact on the perioperative care of the patients, either directly or indirectly. To develop specific preparations and changes in inpatient management to make surgery safer, adequate foresight in this area is helpful. The PAC also aids in risk assessment and offers a chance to achieve the best preoperative optimisation.

 

AIMS AND OBJECTIVES

AIMS: -

The objective of the study is to assess the airway and difficulty of endotracheal intubation during pre-anaesthetic checkup in different age groups

 

OBJECTIVES: -

The objective of the study is to assess the airway and difficulty of endotracheal intubation during pre-anaesthetic checkup in different age groups

MATERIAL & METHODS

5.1 Study design: An observational study

5.2 Sample size: An observational study will be performed on 60 patients

5.3 Subject selection:

 

5.3.1: INCLUSION CRITERIA:

  1. A) All age group [Younger age less than or equal 18,

Middle age 19-45,

Older age Greater than or equal 46]

  1. B) ASA status -ASA-I, ASA-II, ASA-III

C)Elective surgeries

5.3.2: EXCLUSION CREITERIA:

  1. A) Patients undergoing emergency surgeries
  2. B) Patients who are not willing to take part in this study

 

 STUDY PROCEDUR

After obtaining institutional human ethics committee approval, (IHEC) the study was conducted in the Pre-anesthetic checkup clinic, Department of anesthesiology CHRI,Kelembakkam for a period of 6 months from December     2022      to            June       2023,60 patients  were       included in            the study.After obtaining         the          informed consent the patients subjected        for Elective surgeries with having at least ASA-III grading were included in the study

 

To assess predictive factor for endotracheal intubation according to the three age groups(younger age less than or equal 18yrs, middle age 19yrs-45yrs,older age Greater than or equal 46yrs) The patients who are coming for the pre-anesthetic checkup for fitness before the surgery, patients basic demographic profile inter-incisor gap, buck teeth, length of upper incisors, voluntary protrusion of the mandibular teeth anterior to maxillary teeth, Mallampati score, palate configuration, thyromental distance, compliance of mandibular space, neck length, neck thickness, head and neck movements according to the Wilson’s scoring of airway assessment was investigated.

 

According to Wilsons’s scoring, Patients scoring 5 or less, having easy laryngoscopy; 6-7, moderate difficulty; and those scoring 8-10, have severe difficulty during conventional laryngoscopy.

RESULT

Between Jan 2023 and September 2024, 182 patients consulted the emergency department of the ophthalmological clinic due to PVD-related symptoms. 32 patients were excluded from the study due to insufficient data or poor signal strength on examination scans. Ultimately, we analyzed the data on 150 patients. The baseline demographic and clinical characteristics of the patients are presented in Table 1.

Gender Distribution In Study Population

 

GENDER

FREQUENCY

%

MALE

29

48.30%

FEMALE

31

51.66%

 

 

 

 

Distribution Of Gender In Different Age Groups

 

AGE

MALE

FEMALE

 

 

 

YOUNG AGE

14

6

 

 

 

MIDDLE AGE

6

14

 

 

 

OLD AGE

9

11

 

 

 

 

Bar Diagram for Gender Distribution In Study Population

 

Mallampati Score Distribution in Study Population

MMP

FREQUENCY

%

I

17

28%

II

28

46.60%

III

15

25%

 

Mallampati Distribution in Different Age Groups in Study Population

MMP

YOUNG AGE

MIDDLE AGE

OLD AGE

 

 

 

 

I

13

4

0

 

 

 

 

II

7

13

8

 

 

 

 

III

0

3

12

 

 

 

 

 

Bar Diagram for Mallampati Distribution in Different Age Groups in Study Population

 

Distribution Of Interincisor Gap In Study Population

INTERINCISOR

 

 

GAP

FREQUENCY

%

<3

10

17%

>3

50

83.30%

 

Inter Incisor Gap Distribution In Different Age Groups In Study Population

INTER

YOUNG AGE

MIDDLE AGE

OLD AGE

 

INCISOR GAP

 

 

 

 

 

 

 

 

 

<3

10

20

0

 

 

 

 

 

 

>3

10

0

20

 

 

 

 

 

 

 

Bar Diagram for Distribution of Inter-Incisor Gap In Study Population

 

Distribution Of Buck Teeth in Study Population

BUCK TEETH

FREQUENCY

%

NONE

50

83.30%

MODERATE

6

10%

SEVERE

4

6.66%

 

 

 

 

Buck Teeth Distribution in Different Age Groups In Study Population

BUCK TEETH

YOUNG AGE

MIDDLE

OLD AGE

 

AGE

 

 

 

 

 

 

 

 

 

NONE

17

18

15

 

 

 

 

 

 

MODERATE

2

0

4

 

 

 

 

 

 

SEVERE

1

2

1

 

 

 

 

 

 

 

Bar Diagram for Buck Teeth Distribution in Different Age Groups in Study Population

 

Length Of Upperincisor Distribution In Study Population

LENGTH OF

 

 

UPPERINCISOR

FREQUENCY

%

<=1.5

56

93.33%

>=1.5

4

6.66%

 

Length Of Upper Incisor Distribution In Different Age Groups In Study Population

 

LENGTH OF

 

 

 

UPPER

YOUNG AGE

MIDDLE AGE

OLD AGE

INCISOR

 

 

 

 

 

 

 

<=1.5CM

20

19

17

 

 

 

 

>=1.5CM

0

1

3

 

 

 

 

 

Bar Diagram Forlength Of Upper Incisor Distribution In Different Age Groups In Study Population

 

Protrution Of Mandibular Space Distribution in Study

Population

PROTRUTION OF

 

 

MANDIBULAR

FREQUENCY

%

NO

57

95%

YES

3

5%

 

 

 

 

Protrution Of the Mandible Distribution in Different Age Groups In Study Population

PROTRUSION OF

YOUNG AGE

MIDDLE AGE

OLD AGE

 

THE MANDIBLE

 

 

 

 

 

 

 

 

 

YES

0

1

2

 

 

 

 

 

 

NO

20

19

18

 

 

 

 

 

 

 

Bar Diagram For Protrution Of Mandibular Space Distribution In Different Age Groups In Study Population

Palate Configuration Distribution in Study Population

PALATE CONFIGURATION

FREQUENCY

%

 

 

 

NORMAL

46

76.66%

 

 

 

ARCHING

14

23.33%

 

Inter Incisor Gap Distribution in Different Age Groups In Study Population

PALATE

YOUNG AGE

MIDDLE AGE

OLD AGE

 

CONFIGURATION

 

 

 

 

 

 

 

 

 

NORMAL

15

15

16

 

 

 

 

 

 

ARCHING

5

5

4

 

 

 

 

 

 

 

Bar Diagram for Palate Configuration Distribution in Different Age Groups in Study Population

 

Distribution Of Thyromental Distance In Study Population

TMD

FREQUENCY

%

 

 

 

<5

5

8.33%

 

 

 

>5

55

91.66%

 

Tmd Distribution In Different Age Groups In Study Population

TMD

YOUNG AGE

MIDDLE AGE

OLD AGE

 

 

 

 

<5CM

2

1

2

 

 

 

 

>5CM

18

19

18

 

 

 

 

 

Bar Diagram For Tyromental Distance Distribution In Different Age Groups In Study Population

 

 

Complains Of Mandible Distribution In Study Population

COMPLAIONS OF

 

 

THE MANDIBLE

FREQUENCY

%

YES

1

1.66%

 

 

 

NO

59

98.33%

 

 

 

 

Complains Of The Mandible Distribution In Different Age Groups In Study Population

COMPLAINS OF

YOUNG AGE

MIDDLE AGE

OLD AGE

 

THE MANDIBLE

 

 

 

 

 

 

 

 

 

YES

0

1

1

 

 

 

 

 

 

NO

20

19

19

 

 

 

 

 

 

 

Bar Diagram for Complains of Mandible Distribution in Different Age Groups in Study Population

Distribution Of Neck Length In Study Population

NECK LENGTH

 

 

DISTRIBUTION

FREQUENCY

%

>=8

55

91.66%

<=8

5

8.33%

 

Neck Length Distribution in Different Age Groups in Study Population

 

NECK

YOUNG AGE

MIDDLE AGE

OLD AGE

 

LENGTH

 

 

 

 

 

 

 

 

 

>=8CM

19

19

17

 

 

 

 

 

 

<8CM

1

1

3

 

 

 

 

 

 

 

Bar Diagram of Neck Length Distribution in Study Population

 

Distribution Of Neck Thickness In Stud Population

NECK

 

 

THICKNESSS

 

 

 

FREQUENCY

%

>33

44

73.33%

<33

16

26.66%

 

Neck Thickness Distribution in Different Age Groups in Study Population

NECK

YOUNG AGE

MIDDLE

OLD AGE

 

THICKNESS

AGE

 

 

 

 

 

 

 

 

<33MM

16

0

20

 

 

 

 

 

 

>33MM

4

20

0

 

 

 

 

 

 

 

Bar Diagram of Neck Thickness Distribution in Different Age Groups in Study Population

Distribution Of Head And Neck Movement In The Study Popoulation

Head And Neck

 

 

Movement

Frequency

%

<90 Degree

2

3.33%

 

 

 

>90 Degree

58

96.66%

 

Head And Neck Movent Distribution In Different Age Groups In Study Population

Head And Neck

Young

Middle

Old Age

 

Movement

Age

Age

 

 

 

 

 

 

 

>90 Degree

20

19

19

 

 

 

 

 

 

<90 Degree

0

1

1

 

 

 

 

 

 

 

Bar Diagram of Head and Neck Movement Distribution in Different Age Groups in Study Population

 

Distribution Of Wilson’s Score In The Study Population

WILSON’S

 

 

SCORE

FREQUENCY

%

<=5

56

93.33%

6-7

3

5%

8-10

1

1.66%

 

Wilson’s Scoring Distribution In Different Age Groups In Study Population

 

WILSON'S

YOUNG

MIDDLE

OLD AGE

 

SCORE

AGE

AGE

 

 

 

 

 

 

 

<5

20

19

17

 

 

 

 

 

 

6 To7

0

1

2

 

 

 

 

 

 

8 To 10

0

0

1

 

 

 

 

 

 

 

Bar Diagram of Wilson’s Scoring Distribution in Different Age Groups In Study Population

 

CHI-SQUARE TEST

Age Groups

Easy

Moderate

Difficult

 

 

 

 

Young Age

20

0

0

 

 

 

 

Middle Age

19

1

0

 

 

 

 

Old Age

17

2

1

 

 

 

 

 

P Value =0.21192

 

 

 

 

 

DISCUSSION

Ages 40 to 59, being a man, and being fat were all included as risk factors for difficult endotracheal intubation by Rose and Cohen [13]. The age distribution for difficult endotracheal intubation is higher (median value: 54.7, 39.7-66.2 years) than the age distribution for simple endotracheal intubation (median value: 46.5, 34.1-59.9 years)

 

Additionally, according to Ezri et al. [14], laryngoscopy grades and airway classes rise with advancing age, most likely as a result of alterations in bone joints and bad dental health.

 

The study is based on endotracheal intubation among 60 patients in different age groups.The result is based on the descriptive statistics and Chi-square test .The objective of the study is to predict difficulty in endotracheal intubation in different age groups based on pre-anaesthetic checkup.The patients are divided into three groups as young,middle and elderly.The age group comes under 18yrs is considered as young age.the patients comes between the age group of 19 to 45 is considered as middle age and the age group above 45yrs is considered as old age group.

 

The patients who are coming for the pre-anesthetic check-up for fitness before the surgery, patients’ basic demographic profile inter-incisor gap, buck teeth, length of upper incisors, voluntary protrusion of the mandibular teeth anterior to maxillary teeth, mallampathi score, palate configuration, thyromental distance, compliance of mandibular space, neck length, neck thickness, head and neck movements according to the Wilson’s scoring of airway assessment was investigated. Based on the Chi-square test the cross tabulation between easy,moderate and severe difficulty in intubation has p(0.21192) which is doesn’t have much significant correlation with easy/moderate and severe difficult intubation of different age groups.

 

Mallampati scale than the younger age group. In the elderly population (42.7%), the percentage of patients with an Arné score greater than 11 was highest. In comparison to the young age group, cervical joint rigidity was higher in the old and medium age groups.As persons aged, there were differences in the three groups' measurements of head and neck mobility, thyromental distance, and inter-incisor gap. The elder age group had lower oral health than the other two age groups, while the older and middle-aged groups fared better on the Mallampati scale than the younger age group. The proportion of patients with an Arné score above 11 was highest in the older group. The cervical joint rigidity was greater in the old and middle age groups compared to the young age group.

 

And he concluded that Middle-aged or elderly adults are more prone to struggle with endotracheal intubation compared to younger people, and the risk factors may differ by age group. In compared to our study there is no relation between age and difficult tracheal intubation

 

In a study of Dawit Tafesse et al in 2016 conducted a study on “Predictors of Difficult Tracheal Intubation on Adult Elective Patients in a Teaching Hospital”and found that 120 out of 160 adult patients who were scheduled to have elective surgery under general anaesthesia and endotracheal intubation and met the inclusion criteria were used in this study. 39 and 81female patients took part in the study. The mean+SD age of the patients was 37.3+10.8 years. 118 patients had a BMI under 25 kg/m2, of whom 3 required challenging intubation but this was not statistically significant, and 2 had a BMI over 25 kg/m2 but both were straightforward to intubate. The remaining 115 patients had TMD > 6.5cm, and only two of them were challenging to intubate. Of the 5 patients with TMD 6.5cm, 4 had straightforward intubation and 1 had difficult intubation. SMD >12 cm and SMD 12 cm were present in 117 and 3 patients, respectively, although the three patients who had trouble being intubated belonged to the SMD >12 cm group. IIG measurements were >3 cm in 119 and 3 cm in 1, respectively, and all patients in the latter group were easily intubated.Only one difficult intubation was observed out of 116 Mallampati class I&II patients, but out of 4 Mallampati class III&IV patients, difficult intubation occurred in 3 patients who were also CL laryngoscope grade III&IV, which is highly significant within the group. And concluded that since difficult intubation occurs occasionally, anesthesiologists should be prepared for challenging airway care even in patients who appear to be in good health. Furthermore, when used alone, not all preoperative screening tests accurately predict problematic intubation. Combining a few tests may help in determining the genuine difficulty. However, the likelihood of a challenging endotracheal intubation in adult patients can be predicted solely by Mallampati classes III&IV. In our study age is not a factor for difficult tracheal intubation and its predictive factors are varying by different age groups.Low MMP score is the primary factor linked to difficult endotracheal intubation in middle-aged patients.

CONCLUSION

The study’s findings shows that the age is not a factor for difficult endotracheal intubation and its predictive factors are varying by different age groups.

REFERENCE
  1. Apfelbaum JL, Connis RT, Nickinovich DG, Pasternak LR, Arens JF, Caplan RA, Fleisher LA, Flowerdew R, Gold BS, Mayhew JF, Rice LJ. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012 Mar;116(3):522-38.
  2. Haq ZA, Murthy P, Malik I, Lahori VU, Chaudhary S, Ahuja S. Detection of comorbid illnesses during pre-anaesthesia evaluation in a university teaching hospital: A prospective observational study. The National medical journal of India. 2014 Sep 1;27(5).
  3. van Klei WA, Moons KG, Rutten CL, Schuurhuis A, Knape JT, Kalkman CJ, Grobbee DE. The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay. Anesthesia & Analgesia. 2002 Mar 1;94(3):644-9.
  4. Porcaro AB, Rizzetto R, Bianchi A, Gallina S, Serafin E, Panunzio A, Tafuri A, Cerrato C, Migliorini F, Zecchini Antoniolli S, Novella G. American Society of Anesthesiologists (ASA) physical status system predicts the risk of postoperative Clavien–Dindo complications greater than one at 90 days after robot-assisted radical prostatectomy: final results of a tertiary referral center. Journal of Robotic Surgery. 2023 Jun;17(3):987-93.
  5. Benumof JL, Scheller MS. The importance of transtracheal jet ventilation in the management of the difficult airway. The Journal of the American Society of Anesthesiologists. 1989 Nov 1;71(5):769-78.
  6. Bellhouse CP, Doré C. Criteria for estimating likelihood of difficulty of endotracheal intubation with the Macintosh laryngoscope. Anaesth Intensive Care 1988; 16(3): 329-37.
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