Znaczenie wywiadu anestezjologicznego w przewidywaniu trudności intubacyjnych

Magdalena Łasińska-Kowara, Janina Suchorzewska, Anna Wądrzyk, Magdalena Sidorowicz

Summary
Background. Unexpected difficult intubation may create a life-threatening condition. Therefore, a careful preoperative interview should allow for at least partial prediction of a potentially difficult situation. Methods. 511 adult patients were interviewed before anaesthesia with a special attention to the previous clinical records and graded, according to the risk of difficult intubation, as class 0, 1 or 2. During induction, we have noted: the visibility of the larynx using the grading system introduced by Cormack and Lehane (CL), the need of adjuvant manoeuvres and/or equipment and experience of an anaesthetist. Intubation was rated moderately difficultly if two attempts were made or adjuvant manoeuvres and/or equipment were used and significantly difficult – if more than two attempts were made, McCoy laryngoscope or a fiberoptic bronchoscope was used or if a second senior anaesthesiologist was for assistance. Results. Among 404 patients in whom the preoperative interview did not indicate the risk of difficult intubation (class 0), 41 had a vocal cords which were not possible to visualize, 40 had a trachea which was moderate, and 14 – significantly difficult to intubate. Among 104 patients graded as class 1, 31 had vocal cords which were not possible to visualize, 14 – had a trachea which was moderate, and 13 – significantly difficult to intubate. Two patients were graded as very risky (class 2); one of them was intubated without problems, and the second – after several attempts during second anaesthesia. Conclusions. The probability of difficult laryngoscopy and intubation was 2.5 times higher in the grade 1 and 2 patients. Therefore, a careful preoperative interview is extremely important; all intubation-associated incidents should be fully documented.

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