Change in management of predicted difficult airways following introduction of video laryngoscopes

Table 1 El-ganzouri airway assessment score

Score	0	1	2
Interincisor gap	> 4 cm	< 4 cm	Cannot open mouth
Head/neck movement	> 90 degrees	90 degrees	< 90 degrees
Buck teeth	Can prognath edentulous	Can approximate teeth only	Cannot approximate teeth
Thyromental distance	> 6.5 cm	6.0-6.5 cm	< 6.5 cm
Body weight	< 90 kg	90-110 kg	> 110 kg
Hx of difficult intubation	None	Questionable	Definite
Mallampati classification	I	II	III

Table 2 Patient characteristics n (%)

	Pre-VL	Post-VL
	Mean ± SD	Mean ± SD	P value
Age	55 ± 14	57 ± 14	0.2435
Height (m)	1.71 ± 0.11	1.69 ± 0.11	0.0658
Weight (kg)	108 ± 30	97 ± 26	0.00011
BMI	37 ± 10	34 ± 9	0.00141
ASA Status	2.67 ± 0.62	2.73 ± 0.67	0.3145
Composite Airway Score	4.83 ± 1.21	4.79 ± 1.22	0.7711
	Count (%)	Count (%)
Gender			0.4546
Female	105 (51)	139 (55)
Male	101 (49)	116 (45)
Mallampati score			0.04811
1	5 (2)	6 (2)
2	89 (43)	85 (33)
3	112 (54)	164 (64)
Interincisor gap			0.9033
> 4 cm	142 (69)	180 (71)
< 4 cm	63 (31)	73 (29)
Cannot open mouth	0 (0)	2 (1)
Neck range of motion			0.00841
> 90°	149 (73)	152 (60)
90°	37 (18)	69 (27)
< 90°	19 (9)	34 (13)
Ability to prognath			0.3058
Can prognath	157 (77)	187 (73)
Can approximate teeth	46 (22)	62 (24)
Cannot approximate teeth	2 (1)	6 (3)
Thyromental distance (cm)			0.6811
> 6.5	60 (29)	69 (27)
6.0 – 6.5	128 (62)	162 (64)
< 6.0	18 (8)	24 (9)
Known previous difficult intubation			0.1740
None	162 (79)	213 (84)
Questionable	24 (12)	26 (10)
Definite	19 (9)	16 (6)
Surgery type			0.00851
General	64 (31)	55 (22)
Gynecologic	24 (12)	27 (11)
Neurosurgery	20 (10)	56 (22)
Orthopedic	15 (7)	16 (6)
Other	37 (18)	47 (19)
Spine	38 (18)	36 (14)
Vascular	8 (4)	16 (6)

¹Significantly different between Pre-VL and Post-VL groups. P-value and odd ratio calculated with χ² test and Mantel-Haenszel χ² test. SD: Standard deviation; VL: Video laryngoscope; FOI: Fiberoptic intubation; DL: Direct laryngoscopy.

Table 3 Airway management n (%)

	Pre-VL	Post-VL
	Count (%)	Count (%)	P value
Grade (Cormack-Lehane view obtained)			0.0141
1	86 (57)	149 (75)
2	43 (29)	28 (14)
3	19 (13)	16 (8)
4	2 (13)	5 (3)
Intubation method			< 0.00011
FOI	72 (37)	44 (19)	0.00931
VL	4 (2)	119 (51)	< 0.00011
DL	118 (2)	70 (30)	0.00051
Rapid sequence induction			0.1489
RSI	30 (17)	27 (12)
Rescue LMA used			0.7055
Yes	4 (17)	3 (1)
Patient left intubated			0.5467
Yes	24 (12)	25 (12)

¹Significantly different between Pre-VL and Post-VL groups. P value and odd ratio calculated with χ² test and Mantel-Haenszel χ² test. SD: Standard deviation; VL: Video laryngoscope; FOI: Fiberoptic Intubation; DL: Direct laryngoscopy; LMA: Laryngeal mask airway.