BACKGROUND The Optiscope™ can be used for intubation with minimal neck motion. We retrospectively investigated radiographic predictors of difficult intubation using the Optiscope™ by analyzing preoperative radiographic images. METHODS One hundred eighty-four patients who were intubated with the Optiscope™ under manual in-line cervical stabilization for cervical spine surgery were enrolled. Radiographic indices were measured on preoperative cervical spine lateral X-ray and magnetic resonance imaging images. Difficult intubation was defined as failure or time consumption more than 90 s on the first attempt. To identify significant predictors of difficult intubation using the Optiscope™ and evaluate their diagnostic value, multivariable logistic regression and receiver operating characteristic analyses were used. RESULTS Fourty-seven patients showed difficult intubation. There was no significant difference in radiographic indices between the difficult and easy intubation groups, but higher body mass index (BMI) (26.5 [3.0] vs. 24.6 [3.5] kg/m2, P = 0.001), shorter sternomental distance (SMD) (122.0 [104.0 to 150.0] vs. 150.0 [130.0 to 170.0] mm, P = 0.001), shorter interincisor gap (40.0 [35.0 to 45.0] vs. 43.0 [40.0 to 50.0] mm, P = 0.006), and higher incidence of excessive oral secretions (10.6% vs. 2.9%, P = 0.049) were observed in patients with difficult intubation. In multivariable analysis, BMI (odds ratio [95% confidence interval]; 1.15 [1.03 to 1.28], P = 0.011) and SMD (odds ratio [95% confidence interval]; 0.98 [0.97 to 1.00], P = 0.008) were associated with difficult intubation with the Optiscope™. In receiver operating characterstic analysis, the area under the curve for body mass index was 0.68 (95% confidence interval; 0.60 to 0.77, P < 0.001) and that for sternomental distance was 0.66 (95% confience interval; 0.57 to 0.75, P = 0.001). CONCLUSIONS The incidence of difficult intubation using the Optiscope™ under manual in-line cervical stabilization was 25.5% in cervical spine surgery patients. No significant predictor of difficult intubation with the Optiscope™ was identified among the measured radiographic indices. Although high BMI and short SMD were predictive of difficult intubation with the Optiscope™, their discrimination power was weak.

中文翻译：

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一项回顾性研究表明，没有影像学指标可以预测使用Optiscope™对颈椎手术患者进行困难的插管。

背景技术Optiscope™可用于以最小的颈部运动进行插管。我们通过分析术前X线影像回顾性研究了使用Optiscope™进行困难插管的X线影像预测因素。方法入选了144例在手动直插式颈椎稳定器下经Optiscope™插管进行颈椎手术的患者。在术前颈椎侧面X射线和磁共振成像图像上测量射线照相指数。插管困难定义为首次尝试失败或耗时超过90 s。为了确定使用Optiscope™进行插管困难的重要预测指标并评估其诊断价值，使用了多变量logistic回归和接收器操作特征分析。结果47例患者显示难以插管。困难插管组和容易插管组之间的影像学指标没有显着差异，但是较高的体重指数（BMI）（26.5 [3.0] vs. 24.6 [3.5] kg / m2，P = 0.001），胸骨小距离（SMD）更短（122.0 [104.0至150.0] vs.150.0 [130.0至170.0] mm，P = 0.001），门齿间隙更短（40.0 [35.0至45.0] vs.43.0 [40.0至50.0] mm，P = 0.006），且发生率更高在插管困难的患者中观察到过量的口腔分泌物（分别为10.6％和2.9％，P = 0.049）。在多变量分析中，BMI（赔率[95％置信区间]； 1.15 [1.03至1.28]，P = 0.011）和SMD（赔率[95％置信区间]； 0.98 [0.97至1.00]，P = 0.008）为与Optiscope™插管困难有关。在接收机工作特性分析中，体重指数曲线下的面积为0.68（95％置信区间； 0.60至0.77，P <0.001），而胸骨间距离的曲线下面积为0.66（95％置信区间； 0.57至0.75，P = 0.001）。结论在颈椎手动手术中，使用Optiscope™在手动在线颈椎稳定术下进行困难插管的发生率为25.5％。在测量的射线照相指数中，没有发现使用Optiscope™进行困难插管的重要预测指标。尽管BMI高和SMD短可预示Optiscope™插管困难，但其辨别力较弱。结论在颈椎手动手术中，使用Optiscope™在手动在线颈椎稳定术下进行困难插管的发生率为25.5％。在测量的射线照相指数中，没有发现使用Optiscope™进行困难插管的重要预测指标。尽管BMI高和SMD短可预示Optiscope™插管困难，但其辨别力较弱。结论在颈椎手动手术中，使用Optiscope™在手动在线颈椎稳定术下进行困难插管的发生率为25.5％。在测量的射线照相指数中，没有发现使用Optiscope™进行困难插管的重要预测指标。尽管BMI高和SMD短可预示Optiscope™插管困难，但其辨别力较弱。