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..
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
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:
Middle age 19-45,
Older age Greater than or equal 46]
C)Elective surgeries
5.3.2: EXCLUSION CREITERIA:
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.
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 |
|
|
|
|
|
|
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.
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.