ZR-Objective Airway Inter-Rater Reliability(11-9-15)
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Digital images of oral cavities were analyzed by 7 raters to test inter-rater reliability of measurements. Raters measured areas of the total oral cavity, tongue, teeth, and empty spaces. Low average standard deviations and variances between raters demonstrated high inter-rater reliability for the digital imaging analysis method. This objective analysis technique aims to improve predictions of difficult intubation by eliminating subjectivity compared to prior subjective tests.
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The document outlines the importance of preoperative airway assessment to identify potential difficulties in ventilation and intubation, which can lead to significant complications during anesthesia. It discusses various predictors of difficult airways, assessment methods, and classification systems to evaluate these risks, highlighting specific anatomical and clinical factors contributing to airway difficulty. Additionally, it emphasizes the need for systematic assessment of the airway to ensure proper planning and management for anesthetic procedures.CRNA
CRNACory York
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This document summarizes research on using sonography (ultrasound) to predict difficult intubations compared to traditional pre-anesthetic airway assessment methods. Several studies found that sublingual ultrasound was more accurate at identifying difficult laryngoscopy grades than individual traditional measures like Mallampati score and thyromental distance. However, the clinical value of screening tests remains limited. More research is needed to validate ultrasound techniques and compare ultrasound to combined traditional methods.Difficult airway-assessment
Difficult airway-assessmentHossam atef
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The document discusses the assessment of difficult airways. It begins by defining different types of difficult airways including difficult mask ventilation, difficult laryngoscopy, and difficult tracheal intubation. It then discusses various predictive tests that can be used for airway assessment including evaluating neck mobility, mandibular space, mouth opening, and Mallampati score. Specific subgroups that may present challenges like pediatrics, obesity, and certain medical conditions are also covered. The document provides an overview of approaches and considerations for difficult airway assessment.Predictors of airway in pediatric anesthesia podgorica 2014
Predictors of airway in pediatric anesthesia podgorica 2014Marijana Kari邸ik
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This document discusses predictors of difficult airways in pediatric anesthesia. It begins by defining a difficult airway as one where a trained anesthesiologist has difficulty with mask ventilation or tracheal intubation. Several tools for assessing airway difficulty in adults are described, including Mallampati classification and Cormack-Lehane grading, as well as adaptations for pediatric patients. Specific anatomic features that can indicate an difficult airway are outlined. The document concludes that age, interincisor gap, neck circumference, and sternomental distance can predict difficult mask ventilation, while age, best oropharyngeal view, neck circumference, and thyromental distance predict difficult laryngoscopy and intubation.Airway management
Airway managementMohamed ELSAYED
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This document discusses various types of breathing circuits and airway management devices. It describes Mapleson breathing circuit classifications and notes that the Magill and Bain systems are efficient for spontaneous and controlled ventilation, respectively. The Jackson Rees or Type F circuit has a larger reservoir bag, allowing for assisted or controlled ventilation, especially in children. The document also outlines various airway assessment techniques, predictors of difficult intubation/mask ventilation, and management strategies and devices for securing the airway, including oral/nasal airways, face masks, laryngeal mask airways, and tracheal intubation equipment.Airway assessment
Airway assessmentDeepa Sinha
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This document discusses difficult airways and methods for assessing airway difficulty. It begins by defining difficult airway and difficult mask ventilation. It then discusses factors that can predispose patients to difficult airways, such as obesity, beard, missing teeth, snoring, and certain medical conditions.
The document outlines several tests and scoring systems that can be used to assess airway difficulty, including the Mallampatti test, thyromental distance, neck mobility, and inter-incisor distance. It provides details on how to perform and interpret these assessment tests. Finally, it discusses several scoring systems like LEMON, Wilson's criteria, and Benumof's 11 parameters that can help predict difficult laryngoscopy.Difficult airway assessment and management by sardar saud abbas
Difficult airway assessment and management by sardar saud abbasKhyber Teaching hospital
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The document discusses difficult airway assessment and management, outlining definitions, causes, assessment predictors, and response plans for anticipated difficult airways. It details the anatomical factors affecting laryngoscopy, various assessment methods, and tools available for managing difficult intubation, such as rigid laryngoscopes and fiber optics. The document also emphasizes the importance of pre-operative preparation and teamwork, presenting structured plans (A, B, C) for addressing challenging airway situations.AIRWAY ANATOMY, DIFFICULT INTUBATION, Supraglotic airway devices, Video Laryn...
AIRWAY ANATOMY, DIFFICULT INTUBATION, Supraglotic airway devices, Video Laryn...Sami Ur Rehman
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This presentation describes basic airway anatomy, preoperative airway assessment, tools for securing airway and algorithm to secure difficult airway.AIRWAY ASSESSMENT FINAL.pptx
AIRWAY ASSESSMENT FINAL.pptxDrArunangshuPalit
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The document provides information on airway assessment and predictors of difficult intubation. It discusses:
1) The importance of airway management expertise and maintaining a patent airway. Failure to do so can be life-threatening.
2) Causes of difficult airway include anatomical issues like limited neck movement, swelling, and deformities as well as medical conditions.
3) Physical tests that can help predict difficult intubation include the Mallampati score, range of neck movement, thyromental distance, and sternomental distance. Group indices like LEMON, Wilson score, and 4 D's can also help assess airway difficulty.BCC4: John Vassiliadis on The Unexpected Difficult Airway
BCC4: John Vassiliadis on The Unexpected Difficult AirwaySMACC Conference
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The document discusses the challenges of intubating patients in emergency departments, highlighting the unpredictability associated with difficult airways. It outlines the importance of adequate training, supervision, and preparation, including the use of checklists and specific assessment parameters for predicting difficult intubations. The author emphasizes the need for experience and planning in managing such critical situations effectively.Ad
ZR-Objective Airway Inter-Rater Reliability(11-9-15)
- 1. Objective Airway Assessments Using Digital Imaging Demonstrates High Inter-rater Reliability ZD Riley1, PS Santago2, PhD, YF Bryan1, MD 1Department of Anesthesiology, Wake Forest School of Medicine 2Department of Computer Science, Wake Forest University Introduction Subjective tests for laryngoscopy and intubation have low predictive values The Mallampati classification is used by anesthesiologists by viewing the anatomic structures in the oral cavity in order to predict ease of intubation Inter-rater reliability of this test however have proven to be low Computer imaging techniques have been used in order predict difficult intubations We used digital imaging to test for inter-rated reliability in an attempt to determine an objective analysis of the anatomic structures in the oral cavity References and Further Reading Year Author Journal Title Findings 1983 SR Mallampati Canadian Anesthetists Society Journal Clinical Sign to Predict Difficult Tracheal Intubation (Hypothesis) Potential for new airway analysis based on tongue/cavity ratio 1985 SR Mallampati Canadian Anesthetists Society Journal A Clinical Sign to Predict Difficult Tracheal Intubation: A Prospective Study5 Testing of 1983 Mallampati airway hypothesis 2010 M Adamus and Fritscherova and S, Hrabalek L. et al Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. Mallampati Test as a Predictor of Laryngoscopic View Mallampati test alone tested to be inaccurate. 2010 K Gupta and PK Gupta Saudi Journal of Anesthesia Assessment of Difficult Laryngoscopy by Electronically Measured Maxillo-Pharyngeal Angle on Lateral Cervical Radiograph: A Prospective Study Accurate prediction of difficult laryngoscopic view with radiological imaging method. 2010 Hukins, Craig Journal of Clinical Sleep Medicine Mallampati Class Is Not Useful in the Clinical Assessment of Sleep Clinic Patients Low sensitivity and specificity with Mallampati in sleep clinic. 2011 CW Connor and S Segal Anesthesia & Analgesia Accurate Classification of Difficult Intubation by Computerized Facial Analysis It is possible to use computer imaging though facial analysis to predict difficult intubation. 2014 CW Connor and S Segal Anesthesia & Analgesia The Importance of Subjective Facial Appearance on the Ability of Anesthesiologists to Predict Difficult Intubation Facial analysis improves accuracy of diagnosis of difficult intubation. Conclusions Methods Digital photographs were taken of research team members The images consisted of the oral cavity with the mouth open and the tongue maximally protruded A total of fourteen images in 7 people were used Each individual was given a brief in-person tutorial on how to perform the analyses as well as provided a written guide Different team members calculated the areas within the image of each individual for the following: total oral cavity area including tongue but minus lips, tongue alone, teeth alone, and unoccupied space by either the tongue or teeth Ratios were then calculated for each structure to the whole oral cavity Means, standard deviations, and variances were then calculated between each raters data in the same fashion that was done for the intra-rater testing The Intra-rater reliability was shown in a previous study (presented in 2014, Riley) Inter-rater reliability was determined next once the method was demonstrated to be valid and consistent Data gathering has begun in patients with anticipated difficult airways Figure 1: Images of devices used by anesthesiologists for laryngoscopy and intubation. From left to right: Laryngoscopes (Macintosh and Miller), Endotracheal Tube, Image of Airway Anatomy Figure 2: Sample image used in performing digital imaging analysis measurements. Image included is of researcher. Area Average Standard Deviation Average Variance Total Oral Cavity 1.018 cm2 1.75122 Tongue 0.71% 7.85765x10-5 Teeth 0.44% 2.88495x10-5 Tongue and Teeth 0.97% .000111393 Unoccupied 0.70% 5.73487x10-5 Overall Averaged STDEVA and VAR.S 0.71% 6.9042x10-5 Results The inter-rater reliability tested in this study was found to be high, as represented by the low averages and standard deviations All seven members performing the analysis received comparable results for all fourteen images used in this particular analysis set Table 1: Standard deviations and variances were calculated for each image. Presented are the averages for those values for all images. Experiment for digital imaging analysis of oral anatomy found high inter-rater reliability Data presents low standard deviations and variances to support method validity Digital areal analysis is expected to prove beneficial for predicting intubation and laryngoscopy difficulty in patients Highly valid method of analysis serves to eliminate subjectivity Intubation tool recommendation and complication likelihood is expected to be objectively found through this method