• Marco Gemma, Luca Buratti, Davide Di Santo, Maria R Calvi, Alfredo Ravizza, Stefano Bondi, Mario Bussi, and Luigi Beretta.
• From the Department of Anaesthesiology (LB, MRC, AR, LB), Department of Otorhinolaryngology - Head and Neck Surgery, Vita-Salute University, San Raffaele Hospital (DDS, SB, MB) and Department of Anaesthesi... more ology, Fatebenefratelli-Melloni Hospital (ASST Fatebenefratelli-Sacco), Milan, Italy (MG). less
• Eur J Anaesthesiol. 2020 Feb 1; 37 (2): 98-104.

BackgroundConsequences of failed endotracheal intubation can be catastrophic and predicting difficulty is therefore a critical issue. There is no consensus on the best way to predict difficulty.ObjectiveTo evaluate the role of transnasal flexible endoscopic laryngoscopy (TFEL), a minimally invasive procedure, in the prediction of difficult intubation.DesignProspective cohort study.SettingSan Raffaele Hospital, Milan, a tertiary university hospital.PatientsOne hundred and sixty nine adults scheduled for elective ear, nose and throat surgery under general anaesthesia with pre-operative TFEL.InterventionIn addition to routine pre-operative evaluation by an anaesthesiologist, glottis exposure during TFEL was assessed with a scoring system similar to the modified Cormack-Lehane (MCL).Main Outcome MeasuresThe extent to which TFEL improves the prediction of difficult direct laryngoscopy, measured with the MCL score, and of difficult intubation, measured with the intubation difficulty scale score.ResultsWhen added to bedside evaluation, TFEL performed during tongue protrusion significantly (P = 0.005) improved the prediction of MCL. The area under the receiver operating characteristics curve was 0.75 [95% confidence interval (CI) 0.67 to 0.83] vs. 0.65 (95% CI 0.58 to 0.74). For the intubation difficulty scale (P = 0.049), the area under the receiver operating characteristics curve was 0.70 (95% CI 0.61 to 0.80) vs. 0.66 (95% CI 0.58 to 0.74).ConclusionTFEL is a useful tool in predicting difficult intubation, improving predictability of routine bedside evaluation.Trial RegistrationClinicalTrials.gov identifier: NCT02671877.

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