Prediction of Difficult Tracheal Videolaryngoscopic Intubation Using El-Ganzouri Risk Index

Open access


Introduction. Unanticipated difficult intubation still exists as a significant problem. El-Ganzouri risk index is a bedside difficult airway evaluation method, which can help determine risk of difficult airways. However, evidence of using of El-Ganzouri risk index in difficult laryngeal visualisation using videolaryngoscopes is limited.

Aim of the Study. Determine the specificity and sensitivity of El-Ganzouri multivariate risk index to predict difficult laryngeal exposure using Storz C-MAC videolaryngoscope equipped with D type blade.

Material and methods. We conducted a study of 29 patients, which were examined using El-Ganzouri risk index before induction of anaesthesia. After induction of anaesthesia videolaryngoscopy was performed using Storz C-MAC videolaryngoscope equipped with D-blade and laryngeal visualisation was graded using Cormack-Lehane scale. After laryngeal visualisation grading endotracheal tube insertion was performed and numbers of attempts as well as complications during intubation were recorded. Sensitivity, specificity, positive and negative predictive values were calculated, receiver operating characteristic curve and area under curve was obtained.

Results. Sensitivity and specificity were 54.2% and 80.0% at El-Ganzouri risk index cut-off value of 2 points. Calculated positive predictive value was 26.7% and negative predictive value was 92.9%. Calculated AUC was 78.3%.

Conclusions. El-Ganzouri risk index shows moderate sensitivity and specificity when used with Storz C-MAC videolaryngoscope. It can be used to predict difficult laryngeal visualization during videolaryngoscopic intubation.

1. Aziz MF, Dillman D, Fu R, Brambrink AM. Comparative Effectiveness of the C-MAC Video Laryngoscope versus Direct Laryngoscopy in the Setting of the Predicted Difficult Airway // Anesthesiology, 2012; 116:629-636

2. Baker P. Assessment Before Airway Management // Anesthesiol Clin, 2015; 33:257-278

3. Cavus E, Thee C, Moeller T, Kieckhaefer J, Doerges V, Wagner K. A randomised, controlled crossover comparison of the C-MAC videolaryngoscope with direct laryngoscopy in 150 patients during routine induction of anaesthesia // BMC Anesthesiol, 2011; 11:6

4. Cook TM, Macdougall-Davis SR. Complications and failure of airway management // Br J Anaesth, 2012; 109

5. Cortellazzi P, Minati L, Falcone C, Lamperti M, Caldiroli D. Predictive value of the El-Ganzouri multivariate risk index for difficult tracheal intubation: A comparison of Glidescope® videolaryngoscopy and conventional Macintosh laryngoscopy // Br J Anaesth, 2007; 99:906-911

6. Eiamcharoenwit J, Itthisompaiboon N, Limpawattana P, Siriussawakul A. The Performance of the Intubation Difficulty Scale among Obese Parturients Undergoing Cesarean Section // Biomed Res Int, 2017; 2017

7. El-Ganzouri AR, McCarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative airway assessment: predictive value of a multivariate risk index // Anesth Analg, 1996; 82:1197-1204

8. Naguib M, Scamman FL, O’Sullivan C, et al. Predictive performance of three multivariate difficult tracheal intubation models: A doubleblind, case-controlled study // Anesth Analg, 2006; 102:818-824

9. Niforopoulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video-laryngoscopes in the adult airway management: A topical review of the literature //. Acta Anaesthesiol Scand, 2010; 54:1050-1061

10. Selvi O, Kahraman T, Senturk O, Tulgar S, Serifsoy E, Ozer Z. Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study // J Clin Anesth, 2017; 36:21-26

11. Serocki G, Neumann T, Scharf E, Dörges V, Cavus E. Indirect videolaryngoscopy with C-MAC D-Blade and GlideScope: A randomized, controlled comparison in patients with suspected difficult airways // Minerva Anestesiol, 2013; 79:121-129

12. Serocki G, Bein B, Scholz J, Dörges V. Management of the predicted difficult airway: a comparison of conventional blade laryngoscopy with videoassisted blade laryngoscopy and the GlideScope // Eur J Anaesthesiol, 2010; 27:24-30

13. Shiga T, Wajima Z, Inoue T, Sakamoto A, & Na; Predicting Difficult Intubation in Apparently Normal Patients // Anesthesiology, 2005; 103: 429-437

14. Sulser S, Ubmann D, Brueesch M, et al. The C-MAC videolaryngoscope compared with conventional laryngoscopy for rapid sequence intubation at the emergency department: study protocol // Scand J Trauma Resusc Emerg Med, 2015; 23:38.

15. Teoh WHL, Saxena S, Shah MK, Sia ATH. Comparison of three videolaryngoscopes: Pentax Airway Scope, C-MACTM, Glidescope® vs the Macintosh laryngoscope for tracheal intubation // Anaesthesia, 2010; 65:1126-1132

16. Xue F-S, Li H-X, Liu Y-Y, Yang G-Z. Current evidence for the use of C-MAC videolaryngoscope in adult airway management: a review of the literature //Ther Clin Risk Manag, 2017; 13: 831-841

Acta Chirurgica Latviensis

The Journal of Riga Stradins University; Latvian Association of Surgeons; Latvian Association of Paediatric Surgeons

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 61 61 9
PDF Downloads 48 48 5