Odległość tarczowo-bródkowa w przewidywaniu trudnej intubacji

*Magdalena Łasińska-Kowara¹, Bronisław Sulkowski², Maria Wujtewicz¹

Summary
Background.Thyromental distance may be assessed during the preanaesthetic visit. Thyromental distance (TMD) is often used for prediction of difficult intubation, but its value is questionable, as it varies with gender or patients´ size and proportions.
Methods. During routine preanaesthetic visits, we measured the thyromental distance in 305 females and 206 males. Conditions for intubation were rated using the Cormack-Lehane scale. We also noted the number of intubation attempts, any additional maneuvers, the need for different laryngoscope blades, and calls for assistance. Laryngoscopy was rated difficult when the glottis could not be visualized (Cormack-Lehane 3-4). Intubation was rated as impeded if more than one attempt was made or additional maneuvers were necessary. It was rated as difficult if a special laryngoscope or fiberscope was needed and/or another anaesthesiologist was called for assistance.
Results. Moderately difficult intubations were encountered in 54 patients (9.71%) and the intubation was rated difficult in 28 patients (5.38%). The mean thyromental distance was significantly shorter in females. A thyromental distance, shorter than 7 cm in females, and shorter than 8 cm in males, was associated with a higher chance of difficult intubation, although the rate of false predictions was high. The likelihood ratio of a difficult intubation for these distances was 2.34 in females and 1.87 in males.
Discussion and conclusion. The measurement of thyromental distance may help to predict difficult intubation. The statistical parameters of the test are different for male and female patients. In general, difficult intubation should be expected in patients with a short thyromental distance.

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