Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical s

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RESEARCH ARTICLE

Open Access

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery Bingchuan Liu1,2†, Yanan Song3†, Kaixi Liu3, Fang Zhou1,2, Hongquan Ji1,2, Yun Tian1,2* and Yong Zheng Han3*

Abstract Background: We aimed to distinguish the preoperative radiological indicators to predict the application of assistant techniques during intubation for patients undergoing selective cervical surgery. Methods: A total of 104 patients were enrolled in this study. According to whether intubation was successfully accomplished by simple Macintosh laryngoscopy, patients were divided into Macintosh laryngoscopy group (n = 78) and Assistant technique group (n = 26). We measured patients’ radiographical data via their preoperative X-ray and MRI images, and compared the differences between two groups. Binary logistic regression model was applied to distinguish the meaningful predictors. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. The highest Youden’s index corresponded to an optimal cut-off value. Results: Ten variables exhibited significant statistical differences between two groups (P < 0.05). Based on logistic regression model, four further showed correlation with the application of assistant techniques, namely, perpendicular distance from hard palate to tip of upper incisor (X2), atlanto-occipital gap (X9), angle between a line passing through posterior-superior point of hard palate and the lowest point of the occipital bone and a line passing through the anterior-inferior point and the posterior-inferior point of the second cervical vertebral body (Angle E), and distance from skin to hyoid bone (MRI 7). Angle E owned the largest AUC (0.929), and its optimal cut-off value was 19.9° (sensitivity = 88.5%, specificity = 91.0%). the optimal cut-off value, sensitivity and specificity of other three variables were X2 (30.1 mm, 76.9, 76.9%), MRI7 (16.3 mm, 69.2, 87.2%), and X9 (7.3 mm, 73.1, 56.4%). Conclusions: Four radiological variables possessed potential ability to predict the application of assistant intubation techniques. Anaesthesiologists are recommended to apply assistant techniques more positively once encountering the mentioned cut-off values. Keywords: Difficult laryngoscope, Assistant intubation technique, Radiological indicator, Clinical study

* Correspondence: [email protected]; [email protected] † Bingchuan Liu and Yanan Song are co –first authors. 1 Department of Orthopaedics, Peking University Third Hospital, Beijing, China 3 Department of Anesthesiology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long a