Ratio of height to sternomental distance; A comparison of common upper airway tests for predicting difficult larygoscopy in elective surgery patients

ABSTRACT

Preoperative evaluation is important in predicting the risk of difficult airway management. Ratio of height to sternomental distance is a new test for predicting difficult laryngoscopy. Analytical cross - sectional study. Guilan University of Medical Sciences, Rash-lran. 1[st] Oct, 2009 to 30[th] Dec, 2010. 470 consecutive patients scheduled for elective surgery undergoing general anesthesia and requiring endotracheal intubation. The tests that were used to predict difficult laryngoscopy included mouth opening range, body mass index [BMl], thyromental distance, sternomental distance, and neck movement range, ratio of height to thyromental distance, ratio of height to sternomental distance [RHSMD] and assessment of oropharyngeal view by modified Mallampati classification. After general anesthesia, glottic visualization was assessed during laryngoscopy using Cormack and Lehane classification. Multivariate analysis and 95 percent confidence interval with SPSS 14 statistical package were used to compare the results of study. Neck movement range sensitivity and specificity. Then Mallampati class 3 or 4 and RHSMD >/= 12.5 were valuable respectively. Odds ratio [95 percent confidence interval] of the neck movement range /= 12.5 and RHTIVID >/= 23.5 were 17.7[9.57 - 49.76], 12.28 [7.6 - 47.04], 12.22 [22.8-76.6], 9.35 [2.29 -10.52], 5.6 [0.08 - 0.89], 3.78 [0.022 - 0.595] respectively. RHSMD had the least false negative value. Cut off point of RHSMD >/= 12.5 and RHTMD >/= 23.5 was not different between men and women. RHSMD is a useful and valuable clinical screening test for predicting difficult laryngoscopy.