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Observational Study
. 2017 Apr-Jun;20(2):207-211.
doi: 10.4103/aca.ACA_229_16.

Thyromental height test for prediction of difficult laryngoscopy in patients undergoing coronary artery bypass graft surgical procedure

Nilesh Jain  1 , Sucharita Das  1 , Muralidhar Kanchi  1
Affiliations
Observational Study

Thyromental height test for prediction of difficult laryngoscopy in patients undergoing coronary artery bypass graft surgical procedure

Nilesh Jain et al. Ann Card Anaesth. 2017 Apr-Jun.

Abstract

Background: Patients undergoing coronary artery bypass graft (CABG) procedures have higher incidence of difficult laryngoscopy and intubation than general surgery population. Accurate prediction of difficult laryngoscopy in CABG patients is desirable to reduce the hemodynamic response and myocardial oxygen requirements. Recently, thyromental height test (TMHT) has been proposed as one of the highly sensitive and specific bedside tests to predict difficult airway. We, in our prospective observational study, evaluated the accuracy of the TMHT in predicting difficult laryngoscopy.

Methodology: A total of 345 patients undergoing CABG of either sex, in the age group of 35-80 years, American Society of Anesthesiologists 111, undergoing CABG, were studied. Airway assessment was performed with modified Mallampati test with the addition of thyromental distance, sternomental distance, and TMHT. Intraoperatively, direct laryngoscopy was done in accordance with Cormack and Lehane grade of laryngoscopy. The preoperative data and laryngoscopic findings were used together to evaluate the accuracy of TMHT. The sensitivity, specificity, positive and negative predictive values of other three tests were calculated according to standard formula.

Results: A total of 345 patients were in the group with mean age of study population at 56.7 (standard deviation 9.1) years (35-80 years). This study showed that almost all tests had good specificity, but sensitivity was poor. However, sensitivity of TMHT was 75% with accuracy of 95%. Receiver operating characteristic curve analysis of TMHT-derived cutoff was 52.17 which increased sensitivity to 81.25% and specificity to 92.3%.

Conclusion: TMHT had a higher sensitivity compared to other tests along with good positive and negative predictive value and a very high specificity.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Measurement of thyromental height; while the patient lies supine with her/his mouth closed, the line
Figure 2
Figure 2
Measurement of thyromental height using a depth gauge
Figure 3
Figure 3
All the parameters are compared as obtained by the various tests
Figure 4
Figure 4
Receiver operating characteristic curve
See this image and copyright information in PMC

References

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