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Anaesthesiology Intensive Therapy
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3/2020
vol. 52
 
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abstract:
Original paper

A new simple score for prediction of difficult laryngoscopy: the EL.GA+ score

Antonio Corrente
1
,
Marco Fiore
1
,
Salvatore Di Colandrea
2
,
Caterina Aurilio
1
,
Maria Beatrice Passavanti
1
,
Vincenzo Pota
1
,
Pasquale Sansone
1
,
Giacomo Diana
3
,
Giuseppe Signoriello
4
,
Maria Caterina Pace
1

  1. Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
  2. Division of Anesthesia and Intensive Care, “Santa Maria delle Grazie” Hospital, Pozzuoli, Italy
  3. Division of Anesthesia and Intensive Care, Hospital of Marcianise, Marcianise, Italy
  4. Department of Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
Anaesthesiol Intensive Ther 2020; 52, 3: 206–214
DOI: https://doi.org/10.5114/ait.2020.97775
Online publish date: 2020/08/06
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Background
Preoperative airway assessment plays a key role in the context of difficult airway management. Several scores have been proposed to predict difficult intubation including the el-Ganzouri index (EL.GA). Anatomical parameters such as the opening of the mouth or the circumference of the neck (which currently is not usually evaluated) are used to predict difficult intubation. The nutritional status of super-morbid obesity (body mass index [BMI] > 50 kg m-2) is a recognised risk factor for difficult intubation.

Methods
This is a single-centre, retrospective, observational study whose aim is to validate an additional parameter (anatomical plus nutritional) to the El.GA index, hence the choice of the acronym for the definition of the study: EL.GA+, in predictivity of airway management; multiple logistic regression analysis was performed to determine the predictive role of BMI, neck circumference and opening of the mouth of intubation difficulty measured with the gold standard.

Results
In total, 240 patients who had an elective surgical procedure under general anaesthesia, requiring endotracheal intubation, were examined. The predictive value of the EL.GA score was confirmed by the values of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) according to the data reported in the literature. Furthermore, based on the values of the PPV and NPV (0.69 and 0.60 respectively), neck circumference of 42.5 cm can be taken as a cut-off value for which EL.GA+ becomes predictive of difficult intubation in patients with mild obesity (BMI of 30 to 35).

Conclusions
The EL.GA+ score greatly increases the prediction of difficult laryngoscopy in mildly obese patients.

keywords:

airway management, decision support techniques, difficult airways, intratracheal intubation, el-Ganzouri index
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