Predictive parameters of difficult intubation in thyroid surgery: a meta-analysis

Area of Science:

• Anesthesiology
• Otolaryngology
• Surgical Risk Assessment

Background:

• Airway management is a critical aspect of anesthesiology.
• Difficult laryngoscopy occurs in 6.8%–9.6% of patients undergoing thyroid surgery.
• Preoperative airway evaluation aids in predicting difficult airway management.

Purpose of the Study:

• To identify risk factors and physical findings predicting difficult intubation in thyroid surgery.
• To enhance preoperative assessment for thyroid surgery patients.
• To reduce the incidence of difficult airway management during thyroidectomy.

Main Methods:

• Systematic review and meta-analysis of MEDLINE, EMBASE, and CENTRAL databases.
• Inclusion of studies evaluating clinical findings for difficult intubation prediction.
• Exclusion of studies using advanced airway devices or ultrasound.

Main Results:

• Eight studies (5853 patients) were reviewed; 7.21% experienced difficult intubation.
• Predictive factors for difficult intubation: Mallampati Score ≥3 (OR 4.75), shorter thyromental distance (<6.5 cm, OR 3.64), low interincisor gap (<4.4 cm, OR 2.57), tracheal deviation (OR 2.06), obesity (BMI >30, OR 1.95), and male gender (OR 1.54).
• Histology positive for cancer, mediastinal goiter, mandibular protrusion, neck circumference, and neck mobility were not significant predictors in this analysis.

Conclusions:

• High Mallampati Score, short thyromental distance, limited interincisor gap, tracheal deviation, obesity, and male gender are significant risk factors for difficult intubation in thyroid surgery.
• These parameters are essential for preoperative assessment to anticipate and manage difficult airways.
• Tracheal deviation is uniquely linked to thyroid pathology in predicting intubation difficulty.