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Middle East J Anaesthesiol. 2012 Oct;21(6):823-7.

Interobserver variability for non-invasive prediction of difficult intubation in different years of anesthesiology residency.

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Faculty of Medicine, Department of Anesthesiology and Reanimation, Hacettepe University, 06100 Sihhiye/Ankara, Turkey.



The incidence of a difficult laryngoscopy/intubation, which could lead to failed intubation is in the range of 1.5%-13%. Failed intubation may lead to hypoxia, brain damage or death. Preoperative evaluation of the airway can be accomplished by non-invasive bedside clinical tests during physical examination. We studied interobserver variability for non-invasive prediction of difficult intubation in different anesthesiology residency years.


Three hundred eighty four adult patients undergoing elective surgery with general anesthesia and endotracheal intubation were enrolled this study. The investigators were divided in to two groups: three of them were in 4th (Group 1) and the other three were in 1st (Group 2) year of their anesthesiology residency. The variables evaluated were age, weight, height, submental-cervical angle, measurements of mandibular space, deviation of trachea, jaw-hyomental distance, swelling or scar tissue at neck, limited mouth opening, small mouth cavity, macroglossia, cleft lip-palate, long teeth and modified Mallampati score.


The incidence of difficult intubation is 4.9%. Group 1 is more successful than Group 2 in predicting difficult intubation.


Regarding Mallampati score, measurements of mandibular space, jaw-hyomental distance, mouth opening and mouth cavity; interobserver variability is detected in predicting difficult intubation among different years of anesthesiology residency. In means of submental-cervical angle, tracheal deviation, swelling or scar tissue at neck and macroglossia, similar results which are statistically significant, are obtained.

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