A new difficult airway management algorithm based upon the El Ganzouri Risk Index and GlideScope videolaryngoscope. A new look for intubation

Minerva Anestesiologica, 09/30/2011

Caldiroli D et al. – Adherence to the decisional process of the algorithm and to GlideScope videolaryngoscopy achieved successful tracheal intubation in the cohort of patients.

Methods

  • Thirteen staff practitioners trained in videolaryngoscopic intubation followed the algorithm from 2008 through 2010.
  • Elective and emergency neurosurgical patients assessed as having an EGRI score of seven and higher underwent flexible fiberoptic bronchoscopy (FFB) intubation while conscious.
  • Those with a score of six and lower were intubated with the GlideScope, excluding patients with morbid obesity or pharyngo-laryngeal or neck tumors.
  • A decision to perform alternative procedures, difficult laryngeal exposure [Cormack and Lehane (CL) grades III-IV], difficult ventilation and failure to intubate were recorded.

Results

  • The decisional rule was applied in 6,276 patients and resulted in six FFB intubations in conscious patients.
  • The overall incidence of CL grade III-IV views was 0.2%.
  • Difficult videolaryngoscopy was found in 14 patients (0.14%) with a score of 6 and lower.
  • Post-hoc examinations of FFB intubations revealed five difficult laryngeal exposures.
  • The positive predictive value was 85.7%, while the negative predictive value was 99.9%.
  • The incidence of difficult ventilation and difficult laryngeal exposure was 0.03%.
  • Two patients with neck tumors were assigned to alternative procedures.

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