DIAGNOSTIC ACCURACY OF HYOMENTAL DISTANCE RATIO FOR PREDICTION OF DIFFICULT VISUALIZATION OF LARYNX
Main Article Content
Keywords
General Anesthesia, Hyomental Distance Ratio, Cormack Lehane Classification.
Abstract
For general Anesthesia most of the time we use ETT and some time it is very difficult to pass ETT and some time it is even impossible to pass ETT which can lead to morbidity and mortality. There are different clinical methods to assess such a difficult intubation before induction of anesthesia like Mallampati classification, upper lip bite test, Lemon score, thyromental distance and hyomental distance ratio.
Objectives: To find the diagnostic accuracy of the hyomental distance ratio for the prediction of difficult visualization of larynx.
Material & Methods: This cross-sectional study was done at Mayo Hospital Lahore. Total 250 patients undergoing elective surgeries with general anesthesia were included. After approval from ethical committee inform consents and their basic demographic detail were taken. All anesthetics procedures and assessments were done by single consultants. Position of patient was supine with firmed head with the table. All Patients were advised to look straight by keeping head in neutral position with mouth close and no swallowing at the time of assessment.
Results: Mean age of patients were 39.12±38.50 years. There were 109(43.6%) Male & 141(56.4%) female cases. 45(18%) cases were assessed as difficult visualization on Cormack Lehane and 50(20%) cases were having difficult visualization on hyomental distance ratio. The sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of hyomental distance ratio was 89.89%, 95.12%, 80%, 97.50% & 94% taking Cormack Lehane as gold standard and P-value was ˂ 0.05.
Conclusion: The diagnostic accuracy of the hyomental distance Ratio was found high for prediction of difficult visualization of larynx by taking Cormack Lehane as gold standard.
References
2. Dar SR, Hussain R, Nazeer T, Tahir A. Comparison of outcome of laryngeal mask airway (LMA Classic) & I-gel devices in patient undergoing general anesthesia in elective surgeries. Pak J Med Health Sci July, 2015; 9(3):1036-1038.
3. Nazeer T, Hussain R, Chaudry T, Ali M, Mehmood T, Younis M, Dar T, Tahir A.Hemodynamic Changes during induction ; comparison of propofol with mixture propofol & ketamine. Pak J Med Health Sci Oct, 2012; 6(4): 1006-1009.
4. Asghar HF, Aziz NK, Tariq N, Ali M, Tahir A, Hussain R, Javaid A, Nazeer T. Comparison of the frequency of hypotension with propofol & mixture of propofol – ephedrine during induction of general anesthesia.Pak J Med Health Sci July, 2019; 13(3):798-799.
5. Hussain U, Tahir A, Javaid Y, Nazeer T, Hussain R. Patient’s Preference Regarding General or Regional Anesthesia for Elective Cesarean Section.Pak J Med Health Sci Jan, 2017; 11(1):409-410.
6. Asim MA, Hussain R, Nazeer T, Ali M. Blind Endotracheal intubation through intubating laryngeal mask airway: Is chandymanuever beneficial?Pak J Med Health Sci Apr, 2013;7(2):496-499.
7. Dar S, Khan MS, Iqbal F, Nazeer T, Hussain R. Comparison of upper lip bite test (ULBT) with mallampati classification, regarding assessment of difficult intubation. Pak J Med Health Sci Apr, 2017;11(2)767-769.
8. Hrithma DR, Rooparani K, Mahadevaiah DR T, Wikas KN. A cross – sectional study on hyomental distance ratio as a new predictor of difficult laryngoscopy in ICU patients. Cureus 2022 May 28; 14(05):e25435.doi:10.7759/cureus.25435.ecollection 2022may.
9. Koundal V, Rana S, Thakur R, Chauhan V, Ekke S, Kumar M. The usefulness of point of care ultrasound (POCUS) in preanesthetic airway assessment. Indian J anaesth 2019 Dec;63(12):1022-1028.doi:10.4103/ija.IJA_492_19.epub2019Dec11.
10. Zheng Z, Wang X, Du R, Wu Q, Chen L, Ma W. Effectiveness of ultrasonic measurement for the hyomental distance and distance from skin to epiglottis in predicting difficult laryngoscopy in children. EurRadiol. 2023Nov;33(11):7849-7856DOI: 10.1007/s00330-023-09757-z.Epub2023May31.
11. Gottlieb M, O'Brien J R, Ferrigno N, Sundaram T. Point-of-care ultrasound for airway management in the emergency and critical care setting. Clin Exp Emerg Med. 2024 Mar;11(1):22-32. doi: 10.15441/ceem.23.094. Epub 2023 Nov 25.
12. Sotoodehnia M, Abbasi N, Bahri R A, Abdollahi A, Baratloo A. Accuracy of airway ultrasound parameters to predict difficult airway using the LEMON criteria as a reference: A cross-sectional diagnostic accuracy study. Turk J Emerg Med. 2023 Jan 2;23(1):38-43. doi: 10.4103/2452-2473.366484. eCollection 2023 Jan-Mar.
13. Petrișor C, Trancă S, Szabo R, Simon R, Prie A, Bodolea C. Clinical versus Ultrasound Measurements of Hyomental Distance Ratio for the Prediction of Difficult Airway in Patients with and without Morbid Obesity. Diagnostics (Basel). 2020 Mar 3;10(3):140. doi: 10.3390/diagnostics10030140.
14. Liu X, Han F, Zhang L, Xia Y, Sun Y Value of the Hyomental Distance Measured With Ultrasound in Forecasting Difficult Laryngoscopy in Newborns.J PerianesthNurs2023 Dec;38(6):860-864. doi: 10.1016/j.jopan.2023.02.004. Epub 2023 Jun 30.
15. Gadepalli C, Stepien KM, Tol G Hyo-Mental Angle and Distance: An Important Adjunct in Airway Assessment of Adult Mucopolysaccharidosis. J Clin Med 2021 Oct 25;10(21):4924. doi: 10.3390/jcm10214924.
16. Huh J, Shin HY, Kim SH, Yoon TK, Kim TK Diagnostic predictor of difficult laryngoscopy: the hyomental distance ratio.AnesthAnalg 2009 Feb;108(2):544-8. doi: 10.1213/ane.0b013e31818fc347.
17. Rao ST, Gowda V, Reddy RV. Hyomental distance ratio as a diagnostic predictor of difficult laryngoscopy. Ind J Applied Res. 2013;3(8):511-3.
18. Wang B, Wang M, Yang F, Zheng C, Yu Y, Xu J, Chen Y, Yao W. Predicting difficult intubation: the hyomental distance ultrasound evaluation is superior to the thyromental distance.Anaesth Crit Care Pain Med 2022 Dec;41(6):101144. doi: 10.1016/j.accpm.2022.101144. Epub 2022 Aug 18.
19. Abraham S, Himarani J, Nancy SM, Shanmugasundaram S, Raja VBK Ultrasound as an Assessment Method in Predicting Difficult Intubation: A Prospective Clinical Study.
J Maxillofacial Oral Surg 2018 Dec;17(4):563-569. doi: 10.1007/s12663-018-1088-1. Epub 2018 Mar 8.