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. 2024 Feb;23(2):163-169.

Comparison of Acromio-Axillo-Suprasternal Notch Index (AASI) with Hyomental Distance Ratio Test (HMDR) in Predicting Difficult Visualization of the Larynx

Alireza Jaffari  1 , Homayoun Aghamohammadi  1 , Mahdis Hamedi  2 , Mohammad Reza Kamranmanesh  1 , Parisa Sezari  3 , Kamran Mottaghi  3
Affiliations

Comparison of Acromio-Axillo-Suprasternal Notch Index (AASI) with Hyomental Distance Ratio Test (HMDR) in Predicting Difficult Visualization of the Larynx

Alireza Jaffari et al. Tanaffos. 2024 Feb.

Abstract

Background: Safe airway management during anesthesia induction is a challenging issue. Airway-related morbidity can be prevented by carefully evaluating patients and formulating a difficult airway management strategy. The purpose of this study is to investigate and compare two indices, AASI, and HMDR, in predicting difficult laryngoscopic visualization.

Materials and methods: Six hundred and twenty-two patients, who entered the operating room for any type of elective surgery and were candidates for general anesthesia, underwent AASI and HMDR measurements after filling out a questionnaire containing personal information, oral examinations, and history of illness or surgery before anesthesia prescription. The Cormack grade was recorded during laryngoscopy, and finally, the predictive value of the two methods was compared.

Results: Based on analysis, AASI has a higher specificity than HDMR (87.5% vs. 76.1%) and the positive predictive value of AASI is 97%. Therefore, both HMDR and AASI are valid and significant indicators for predicting difficult laryngoscopy.

Conclusion: AASI has a better diagnostic profile than HMDR regarding sensitivity and positive predictive value, Additionally, AASI is more convenient to use because it is simpler and visually predictable, making it a reliable clinical predictor.

Keywords: Airway management; Anesthesia; Cormack score; Difficult intubation; Laryngoscopy.

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Figures

Figure 1.
Figure 1.
Receiver operating characteristic curves for the AASI and HMDR (HMDn, HMDe) in the prediction of difficult laryngoscopy. HMDR= hyomental distance ratio; HMDn= Hyomental distance neutral position HMDe=hyomental distance extension; AASI= acromioaxillosuprasternal notch index
See this image and copyright information in PMC

References

    1. Gupta S, Sharma KR, Jain D. Airway assessment: predictors of difficult airway. Indian Journal of Anaesthesia 2005;49(4): 257–62.
    1. Law JA, Duggan LV, Asselin M, Baker P, Crosby E, Downey A, et al. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway. Can J Anaesth 2021;68(9):1405–1436. - PMC - PubMed
    1. Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;136(1):31–81. - PubMed
    1. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984;39(11):1105–11. - PubMed
    1. Kheterpal S, Healy D, Aziz MF, Shanks AM, Freundlich RE, Linton F, et al. Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group. Anesthesiology 2013;119(6):1360–9. - PubMed

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