Nasendoscopy to Predict Difficult Videolaryngoscopy: A Multivariable Model Development Study.

Area of Science:

• Anesthesiology and Airway Management
• Otolaryngology and Head & Neck Surgery

Background:

• Transnasal videoendoscopy (TVE) is standard for pharyngolaryngeal lesion staging.
• Predicting difficult videolaryngoscopic intubation is crucial for patient safety.
• Existing risk indices may not fully capture airway complexity.

Purpose of the Study:

• To evaluate if preoperative TVE improves difficult videolaryngoscopic intubation prediction.
• To assess TVE's added value beyond the Simplified Airway Risk Index (SARI).
• To identify specific TVE findings associated with intubation difficulty.

Main Methods:

• Prospective study including 374 anesthetics (252 with preoperative TVE).
• Primary outcome: difficult airway alert post-Macintosh videolaryngoscopy.
• Multivariable logistic regression (LASSO selection) using SARI, clinical factors, and TVE findings.

Main Results:

• SARI predicted difficult intubation (OR 1.33).
• Adding TVE parameters significantly improved prediction model fit (AIC 311.0 vs. 327.1 for SARI alone, p < 0.001).
• Pharyngeal secretion retention and restricted glottic view were significant predictors.

Conclusions:

• Preoperative TVE significantly enhances the prediction of difficult videolaryngoscopy.
• TVE provides valuable information beyond traditional bedside airway assessments.
• Integrating TVE findings improves preoperative airway risk stratification.