Uji prabedah untuk memperkirakan kesulitan tindakan intubasi trakhea Intubation in Elective Surgical patients

ABSTRACT The aims of the study was to determine the sensitivity and specificity of the three preoperative clinical tests used alone or in combinations in predicting difficult intubation, to determine whether the three preoperative tests, used as a single and combined test with the difficulty in intubation. Three preoperative tests can be used as diagnostic procedure as a single test or combined tests in the prediction of difficult intubation, with at least 80% sensitivity and 80% specificity. There is association between the three preoperative tests and the difficulty with intubation. The study was a prospective, cross-sectional, diagnostic test, conducted in the operating theatre Dr.Cipto Mangunkusumo Hospital, Jakarta The study involved elective surgical patients who need general anesthesia with endotracheal intubation, aged 15-65 years, ASA physical status 1 or 2, no upper airway inflamatory, swelling, tumor and foreign body, and agree to be in eluded in this research. Sample size calculation based on the expected result of diagnostic test are at least 80% sensitivity and 80% specificity with 95% confidence interval with the prevalence 18%, the sample size was 1430. Preoperative clinical tests such as sternomental distance, thyromental distance and oropharyngeal views were measured by 2 Anesthesiology residents who were not involved in tracheal intubation procedures. The direct laryngoscopy procedure is used as a gold standard for diagnosing tracheal intubation. Intubation of trachea was considered as difficult if laryngoscopy grade III or IV of cormack and Lehane\u27scales. It was revealed that intra rater Kappa agreement analysis yielded these values : 93% and 78% for sternomental distance75% and 92% for thyromental distance80% and 93% for oropharyngeal view. The interater agreement for sternomental distance was 83%, thyromental distance was 86% and oropharyngeal view 86%. With stepwise logistic regression combination of thyromantal distance and oropharyngeal view were signifivant in predicting diffcult intubation. The combination between thyromental distance 6.5 cm or less and oropharyngeal view grade III clinical test supported the hypothesis of the study, with its sensitivity, specificity, positive and negative predictive values, positive and negative likelihood rations were 86.95%, 80%, 97%, 40%, 4.34 and 0.16 respectively. Conclusion: The combined test of thyromental distance and oropharyngeal view can be used as a clinical diagnostic tool to detect difficult intubation. Key Word: difficult intubation, sternomental distance, thyromental distance, oropharyngeal vie