Official publication of Rawalpindi Medical University
Diagnostic Accuracy Of Acromioaxillosuprasternal Notch Index For Prediction Of Difficult Airway Taking Cormack And Lehane Grading System As Gold Standard

Supplementary Files

PDF

Keywords

AASI, Cormack and Lehane, Difficult airway intubation.

How to Cite

1.
Sajjad MM, Tariq A, Shabbir M, Yousaf S. Diagnostic Accuracy Of Acromioaxillosuprasternal Notch Index For Prediction Of Difficult Airway Taking Cormack And Lehane Grading System As Gold Standard. JRMC [Internet]. 2023 Sep. 26 [cited 2024 Jun. 25];27(3). Available from: https://journalrmc.com/index.php/JRMC/article/view/2269

Abstract

Background:

General anesthesia is still needed for several surgical interventions and requires endotracheal intubation. The difficult airway is a well-known entity, and a long list of predicting scores is present, yet a high degree of diagnostic accuracy still needs to be improved. Acromioaxillosuprasternal notch index (AASI) has shown some excellent results in recent times.

Objective:

Its objective is to determine the diagnostic accuracy of acromioaxillosuprasternal notch index for predicting difficult airways and to take the Cormack and Lehane grading system as the gold standard.

Methodology:  

In this study, adults of both genders aged 20 to 70 years undergoing any surgery under general anesthesia having ASA class I to IV were included. AASI score of equal or less than 0.49 was taken as difficult airway while on Cormack and Lehane grade; it was labeled as yes where grade III or IV was seen.

Results:

The total number of cases were 350 cases, out of which 218 (62.29%) were males, and 132 (37.71%) were females. The mean age was 40.20±12.86 years, and the mean BMI was 24.71±3.13 (table 17). There were 294 (84%) cases in ASA Class I and II and 56 (14%) in class III and IV. Difficult intubation on AASI was seen in 54 (15.43%) and 57 (16.29%) cases on Cormack and Lehane grading. 

The diagnostic accuracy of AASI for prediction of difficult intubating a difficult was 96.29% with sensitivity of 90.74%, specificity of 97.30%, PPV of 85.96%, NPV of 98.29% with p= 0.001. This difference was also statistically significant with all the confounding variables like age, gender, ASA class, and BMI. 

Conclusion:

The acromioaxillosuprasternal notch index is a

significant predictor for tubing a difficult airway and taking Cormack and Lehane's grading as the gold standard. This difference is considerably better regarding age, gender, BMI, and ASA class. 

https://doi.org/10.37939/jrmc.v27i3.2269

References

Cobley M, Vaughan RS. Recognition and management of difficult airway problems. Br J Anaesth. 1992 Jan;68(1):90-7. doi: 10.1093/bja/68.1.90. PMID: 1739575.

Rajkhowa T, Saikia P, Das D. An observational prospective study of the performance of acromioaxillosuprasternal notch index in predicting difficult visualisation of the larynx. Indian Journal of Anaesthesia. 2018 Dec;62(12):945.

Arné J, Descoins P, Fusciardi J, Ingrand P, Ferrier B, Boudigues D, Ariès J. Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index. Br J Anaesth. 1998 Feb;80(2):140-6. doi: 10.1093/bja/80.2.140. PMID: 9602574.

Khan ZH, Eskandari S, Yekaninejad MS. A comparison of the Mallampati test in supine and upright positions with and without phonation in predicting difficult laryngoscopy and intubation: A prospective study. J Anaesthesiol Clin Pharmacol. 2015 Apr-Jun;31(2):207-11. doi 10.4103/0970-9185.155150. PMID: 25948902; PMCID: PMC4411835.

Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits AM, Arrich J, Herkner H. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst Rev. 2018 May 15;5(5): CD008874. doi 10.1002/14651858.CD008874.pub2. PMID: 29761867; PMCID: PMC6404686.

Kheterpal S, Han R, Tremper KK, Shanks A, Tait AR, O'Reilly M, Ludwig TA. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006 Nov;105(5):885-91. doi: 10.1097/00000542-200611000-00007. PMID: 17065880.

Law JA, Broemling N, Cooper RM, Drolet P, Duggan LV, Griesdale DE, Hung OR, Jones PM, Kovacs G, Massey S, Morris IR, Mullen T, Murphy MF, Preston R, Naik VN, Scott J, Stacey S, Turkstra TP, Wong DT; Canadian Airway Focus Group. The difficult airway with recommendations for management--part 2--the anticipated difficult airway. Can J Anaesth. 2013 Nov;60(11):1119-38. doi: 10.1007/s12630-013-0020-x. Epub 2013 Oct 17. PMID: 24132408; PMCID: PMC3825645.

Kamranmanesh MR, Jafari AR, Gharaei B, Aghamohammadi H, Poor Zamany N K M, Kashi AH. Comparison of acromioaxillosuprasternal notch index (a new test) with modified Mallampati test in predicting difficult visualization of larynx. Acta Anaesthesiol Taiwan. 2013 Dec;51(4):141-4. doi: 10.1016/j.aat.2013.12.001. Epub 2014 Jan 21. PMID: 24529668.

Lee HC, Yun MJ, Hwang JW, Na HS, Kim DH, Park JY. Higher operating tables provide better laryngeal views for tracheal intubation. Br J Anaesth. 2014 Apr;112(4):749-55. doi: 10.1093/bja/aet428. Epub 2013 Dec 18. PMID: 24355831.

J. D. Walker, Posture used by anaesthetists during laryngoscopy†, BJA: British Journal of Anaesthesia, Volume 89, Issue 5, November 2002, Pages 772–774,

Goodman SN, Berlin JA. The use of predicted confidence intervals when planning experiments and the misuse of power when interpreting results. Ann Intern Med. 1994 Aug 1;121(3):200-6. doi: 10.7326/0003-4819-121-3-199408010-00008. Erratum in: Ann Intern Med 1995 Mar 15;122(6):478. PMID: 8017747.

Mehta T, Jayaprakash J, Shah V. Diagnostic value of different screening tests in isolation or combination for predicting difficult intubation: A prospective study. Indian J Anaesth. 2014 Nov-Dec;58(6):754-7. doi: 10.4103/0019-5049.147176. PMID: 25624545; PMCID: PMC4296366.

Brodsky JB, Lemmens HJ, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesth Analg. 2002 Mar;94(3):732-6; table of contents. doi: 10.1097/00000539-200203000-00047. PMID: 11867407.

Lundstrøm LH, Møller AM, Rosenstock C, Astrup G, Wetterslev J. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database. Anesthesiology. 2009 Feb;110(2):266-74. doi: 10.1097/ALN.0b013e318194cac8. PMID: 19194154.

Safavi SM, Honarmand A, Sheikhani G. Comparing “acromio-axillo-suprasternal notch index (AASI)” as a new screening test for predicting difficult laryngoscopy with four commonly used tests. Journal of Isfahan Medical School. 2016 Apr 20;34(375):245-50.

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Copyright (c) 2023 Muhammad Mohsin Sajjad, Amina Tariq, Muhammad Shabbir, Sidra Yousaf