1.Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway
Rishabh AGARWAL ; Gaurav JAIN ; Ankit AGARWAL ; Nishith GOVIL
Korean Journal of Anesthesiology 2021;74(2):134-141
Background:
Predicting difficult intubation (DI) is a key challenge, as no single clinical predictor is sufficiently valid to predict the outcome. We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting DI. The validity of the models using combinations of ultrasonography-based parameters was also investigated.
Methods:
This prospective, observational, double-blinded cohort trial enrolled 1,043 surgical patients classified as American Society of Anesthesiologists physical status I–III without anticipated difficult airway. Preoperatively, their tongue thickness (TT), invisibility of hyoid bone (VH), and anterior neck soft tissue thickness from the skin to thyrohyoid membrane (ST) and hyoid bone (SH) were measured by sublingual and submandibular ultrasonography. The logistic regression, Youden index, and receiver operator characteristic analysis results were reported.
Results:
Overall, 58 (5.6%) patients were classified as DI. The TT, SH, ST, and VH had accuracies of 78.4%, 85.0%, 84.7%, and 84.9%, respectively. The optimal values of TT, SH, and ST for predicting DI were > 5.8 cm (sensitivity, 84.5%; specificity; 78.1%; AUC, 0.880), > 1.4 cm (sensitivity, 81%; specificity, 85.2%; AUC, 0.898), and > 2.4 cm (sensitivity, 75.9%; specificity, 85.2%; AUC, 0.885), respectively. VH had a sensitivity and specificity of 72.4% and 85.6% (AUC, 0.790. The AUC values of the five models (with combinations of three or four parameters) ranged from 0.975–0.992. ST and VH had a significant impact on the individual models.
Conclusions
SH had the best accuracy. Individual parameters showed limited validity. The model including all four parameters offered the best diagnostic value.
2.Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway
Rishabh AGARWAL ; Gaurav JAIN ; Ankit AGARWAL ; Nishith GOVIL
Korean Journal of Anesthesiology 2021;74(2):134-141
Background:
Predicting difficult intubation (DI) is a key challenge, as no single clinical predictor is sufficiently valid to predict the outcome. We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting DI. The validity of the models using combinations of ultrasonography-based parameters was also investigated.
Methods:
This prospective, observational, double-blinded cohort trial enrolled 1,043 surgical patients classified as American Society of Anesthesiologists physical status I–III without anticipated difficult airway. Preoperatively, their tongue thickness (TT), invisibility of hyoid bone (VH), and anterior neck soft tissue thickness from the skin to thyrohyoid membrane (ST) and hyoid bone (SH) were measured by sublingual and submandibular ultrasonography. The logistic regression, Youden index, and receiver operator characteristic analysis results were reported.
Results:
Overall, 58 (5.6%) patients were classified as DI. The TT, SH, ST, and VH had accuracies of 78.4%, 85.0%, 84.7%, and 84.9%, respectively. The optimal values of TT, SH, and ST for predicting DI were > 5.8 cm (sensitivity, 84.5%; specificity; 78.1%; AUC, 0.880), > 1.4 cm (sensitivity, 81%; specificity, 85.2%; AUC, 0.898), and > 2.4 cm (sensitivity, 75.9%; specificity, 85.2%; AUC, 0.885), respectively. VH had a sensitivity and specificity of 72.4% and 85.6% (AUC, 0.790. The AUC values of the five models (with combinations of three or four parameters) ranged from 0.975–0.992. ST and VH had a significant impact on the individual models.
Conclusions
SH had the best accuracy. Individual parameters showed limited validity. The model including all four parameters offered the best diagnostic value.
3.Effects of zolpidem on sleep parameters in patients with cirrhosis and sleep disturbances: A randomized, placebo-controlled trial
Manoj Kumar SHARMA ; Sumeet KAINTH ; Sachin KUMAR ; Ankit BHARDWAJ ; Hemant Kumar AGARWAL ; Rakhi MAIWALL ; Kapil Dev JAMWAL ; Saggere Muralikrishna SHASTHRY ; Ankur JINDAL ; Ashok CHOUDHARY ; Lovkesh ANAND ; Rajender Mal DHAMIJA ; Guresh KUMAR ; Barjesh Chander SHARMA ; Shiv Kumar SARIN
Clinical and Molecular Hepatology 2019;25(2):199-209
BACKGROUND/AIMS: The aim of this study was to study the efficacy and safety of zolpidem for sleep disturbances in patients with cirrhosis. METHODS: Fifty-two Child-Turcotte-Pugh (CTP) class A or B cirrhotics with Pittsburgh Sleep Quality Index >5 were randomized to either zolpidem 5 mg daily (n=26) or placebo (n=26) for 4 weeks. RESULTS: The therapy of 4 weeks was completed by 23 patients receiving zolpidem (3 stopped treatment due to excessive daytime drowsiness) and 24 receiving placebo (2 refused to continue the study). In the zolpidem group, after 4 weeks of therapy, there was significant increase in total sleep time (TST) and sleep efficiency compared to baseline and improvement in polysomnographic parameters of sleep initiation and maintenance (i.e., decrease in sleep latency time, decrease in wake time, and decreases in number of arousals and periodic limbs movements per hour of sleep), without any significant change in sleep architecture. CONCLUSIONS: Four weeks of 5 mg daily zolpidem in CTP class A or B cirrhosis patients with insomnia led to significant increases in TST and sleep efficiency and improvement in polysomnographic parameters of sleep initiation and maintenance without any significant change in sleep architecture.
Arousal
;
Cytidine Triphosphate
;
Extremities
;
Fibrosis
;
Humans
;
Sleep Initiation and Maintenance Disorders