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Acromio-Axillo-Suprasternal Notch Index Performance in Predicting Difficult Visualization of the Larynx: An

Chhaya M Suryawanshi1, Jayant Bhatia1

  • 1Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.

Cureus
|September 12, 2024
PubMed
Summary

The Acromio-Axillo-Suprasternal Notch Index (AASI) effectively predicts difficult laryngeal visualization (DVL) during intubation. This bedside test shows high accuracy, aiding anesthesiologists in managing challenging airways.

Keywords:
acromio-axillo-suprasternal notch indexdifficult airwaydifficult visualization of larynxendotracheal intubationgeneral anesthesialaryngoscopymodified mallampati testpredictive value of tests

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Area of Science:

  • Anesthesiology
  • Airway Management
  • Clinical Prediction Tools

Background:

  • Predicting difficult intubation is crucial for patient safety.
  • Existing bedside screening tests have limitations in accuracy.
  • Difficult laryngeal visualization (DVL) poses significant challenges during endotracheal intubation.

Purpose of the Study:

  • To evaluate the Acromio-Axillo-Suprasternal Notch Index (AASI) as a predictor of difficult laryngeal visualization (DVL).
  • To compare the predictive accuracy of AASI against other established airway assessment methods.

Main Methods:

  • Prospective observational study of 100 adult patients (ASA grade I-II) undergoing elective surgery requiring intubation.
  • Preoperative assessment included AASI, modified Mallampati test (MMT), sternomental distance (SMD), thyromental distance (TMD), and inter-incisor distance (IID).
  • Difficult laryngeal visualization was defined by Cormack-Lehane grades III and IV, assessed by blinded anesthesiologists during direct laryngoscopy.

Main Results:

  • Difficult laryngeal visualization (DVL) occurred in 21% of patients.
  • AASI demonstrated high sensitivity (98.73%) and specificity (71.43%) for predicting DVL.
  • The area under the curve (AUC) for AASI (0.851) was superior to MMT, SMD, TMD, and IID.

Conclusions:

  • The Acromio-Axillo-Suprasternal Notch Index (AASI) is an excellent bedside predictor for difficult laryngeal visualization (DVL).
  • AASI (≥0.5) offers significant clinical utility in identifying patients at risk for challenging intubation.
  • This index can guide anesthesiologists in preparing for and managing potentially difficult airways.