European Journal of Molecular & Clinical Medicine

Background and Aims: Difficult endotracheal intubation is a major challenge for the anesthesiologists. Many parameters assist to predict difficult intubation, hence inter incisor distance (IID), Sternomental distance (SMD) were used to predict the possibility of difficult intubation in patients posted for Head and Neck Oncosurgeries perioperative.
Methods:106 patients, airway was assessed who were posted for head and neck oncosurgeries especially the oral cancer patients. Using Cormack and Lehane laryngoscopic grading was assessed following laryngoscopy and graded difficult intubation as grade 3 and 4.
Results: Difficult endotracheal intubation was found in 20.75% of the said population, which was much higher than general population. Inter incisor distance less than 3 cm, Sternomental distance less than 12.5 cm were the cut off points for difficult intubation. The predicting difficult intubation by inter incisor distance was about 59% sensitivity and 77% specificity with a positive predictive value of 38% and with higher negative predictive value of 88%. The predicting difficult intubation by sternomental distance was about 24% sensitivity and 51% specificity with a positive predictive value of 10 % and with higher negative predictive value of 74% odds ratio of 5.22.
Conclusions: Inter incisor distance had high specificity with significant P value 0.007, hence was a better predictor compared to Sternomental distance in assessing airway in patients posted for head and neck oncosurgeries.

Background: Difficult airway is a condition in which a trained anaesthesiologist has
trouble with complications. Risk factors associated with difficult airway are failure or delay
identifying at risk patients and poor planning. Objectives: To study predictors of difficult
airway intubation in patients undergoing general anaesthesia.
Materials & Methods:Single centre, prospective observational study in which patients
scheduled for surgery were included. In addition to patient’s demographic information,
indication for surgery, modified Mallampati grading, inter incisor distance, neck
circumference was noted. Patients were monitored intraoperatively.
Results: Mean Age was 35.9 ± 14.2 years, majority were of ASA status I (65.5%). Mean
sternomental distance was 15.1 ± 2.1 cm, mean thyromental distance was 6.1 ± 1.1 cm &
ratio of height to thyromental distance (RHTMD) was 23.1 ± 5.1. Mallampati class 3/4 in
supine position were 28.25%, class 3/4 sitting were 19.25%, other significant features were
short muscular neck (10.5%), neck movement <80˚ (4%), inter incisor distance ≤3.5 cm
(4%) & limited mandibular protrusion (2.25 %). Difficult intubation was noted in 8%.
Significant factors associated with difficult intubation were Mallampati class 3/4 (sitting),
increased sternomental distance, increased thyromental distance, increased ratio of height
to thyromental distance (RHTMD), short neck, snoring history, neck movement <80˚, short
inter‑ incisor distance, cervical spondylosis & limited mandibular protrusion.
Conclusion: Significant factors associated with difficult intubation were Mallampati class
3/4 (sitting), more sternomental distance, more thyromental distance, increased ratio of
height to thyromental distance (RHTMD), short neck, snoring history, neck movement
<80˚, inter‑ incisor distance ≤3.5 cm, cervical spondylosis & limited mandibular
protrusion. Predicting difficult intubation during the preoperative assessment is a key
challenge, as no single clinical predictor is sufficiently valid for predicting the outcomes.