Document Detail

Difficult intubation in acromegalic patients: incidence and predictability.
MedLine Citation:
PMID:  10861153     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Previous studies have suggested that the incidence of difficult intubation in acromegalic patients is higher than in normal patients. However, these studies were retrospective and did not include preoperative assessment of the airways. The aims of this study were to determine the incidence of difficult intubation and to assess the usefulness of preoperative tests in predicting difficult laryngoscopy. METHODS: One hundred twenty-eight consenting acromegalic patients requiring general anesthesia and tracheal intubation were studied. Preoperatively, Mallampati classification, thyromental distance, and head and neck movement were determined in each patient. After induction of anesthesia and muscle paralysis, laryngoscopic grade was assessed during direct laryngoscopy; Cormack and Lehane grade III or IV were classified as difficult. The association of individual airway assessment with laryngeal view was evaluated using the Fisher exact test. Predictors of difficult laryngoscopy were evaluated by calculating their sensitivity and specificity. RESULTS: Laryngoscopy was difficult (grade III) in 33 of 128 patients (26%). Application of external laryngeal pressure improved laryngeal visualization to grade II in 20 of these 33 patients. In the remaining 13 patients (10%), intubation was difficult (more than two attempts, blade change, use of gum-elastic bougie). Mallampati classes 3 and 4 were significantly related to laryngoscopy grade III (Fisher exact test, P = 0.001). CONCLUSIONS: The incidence of difficult laryngoscopy and intubation in acromegalic patients is higher than in normal patients. Preoperative Mallampati scores of 3 and 4 were of value in predicting difficult laryngoscopy. Nevertheless, even this test will miss a significant number of patients with a difficult airway.
H Schmitt; M Buchfelder; M Radespiel-Tröger; R Fahlbusch
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  93     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-07     Completed Date:  2000-08-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  110-4     Citation Subset:  AIM; IM    
Department of Anesthesiology, Friedrich-Alexander University, Erlangen-Nuremberg, Germany.
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MeSH Terms
Acromegaly* / surgery
Anesthesia, General*
Intubation, Intratracheal*
Laryngoscopy / statistics & numerical data*
Middle Aged
Preoperative Care
Prospective Studies
Sensitivity and Specificity
Comment In:
Anesthesiology. 2001 Jun;94(6):1149-50   [PMID:  11465613 ]

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