Hasil untuk "Anesthesiology"

Esther Giehl-Brown, Elias Khajeh, Sarah Dehne et al.

Abstract Background Low pneumoperitoneum pressure (LPP) lowers the incidence of CO2 embolisms in minimally invasive liver resections (MILR), while higher pneumoperitoneum pressure (HPP) reduces intraoperative blood loss. This contradiction necessitates careful pressure management especially in major liver resections where intraoperative blood loss greatly impacts postoperative outcome. Methods In this randomized non-inferiority trial, adults undergoing elective MILR for any indication will be recruited in alignment with inclusion and exclusion criteria. After given informed consent, eligible patients will be randomized to either low (≤10 mmHg) or high (≥14 mmHg) pneumoperitoneum pressure during parenchymal transection. Blood, peritoneal biopsies, and liver tissue will be sampled to evaluate intraoperative tissue damage. Sample size (n = 66 patients per group) is calculated based on the current literature. The primary study endpoint is intraoperative blood loss during the parenchymal transection phase. Secondary endpoints include CO2 embolisms, intraoperative tissue damage, operation time, morbidity, mortality, and duration of hospitalization. Discussion Minimizing intraoperative blood loss in MILR is a clinically relevant problem, which greatly impacts the procedure’s safety and influences the patient’s morbidity and mortality. HPP, exerting counter pressure to the vascular pressure, serves for bleeding control in MILR. The risk of CO2 embolism, arising from the combination of high intra-abdominal pressure and low central venous pressure, favors the use of LPP. The proposed trial aims to assess the non-inferiority of LPP compared to HPP during the parenchymal transection phase of MILR. Trial registration ClinicalTrials.gov NCT06770803. First Submitted: 2024-12-30, First Submitted that Met QC Criteria: 2025-01-07, First Posted: 2025-01-13.

A. Mudasir, K. Sanna, M. Nayil et al.

Abstract Background Trigeminal neuralgia is a debilitating condition that often requires surgical intervention. While microvascular decompression (MVD) is a standard surgical approach, we explored the efficacy of fibrin glue as an adjunctive technique in improving patient outcome. Methods Over a three-year period, 16 patients with trigeminal neuralgia underwent MVD with the application of fibrin glue at the conclusion of the procedure. The primary outcome was pain relief, assessed using the Barrow Neurological Institute (BNI) pain intensity scale, with a success defined as BNI Grade I (no pain, no medication required). Results All 16 patients (100%) experienced complete pain relief with no recurrence of symptoms over an average follow-up period of 5-yrs. Additionally, no significant adverse effects were observed related to the application of fibrin glue. Conclusion The adjunctive use of fibrin glue in MVD surgery for trigeminal neuralgia patients appears to enhance surgical outcomes, providing a 100% success rate in our cohort. This technique may offer a promising addition to the standard surgical approach, warranting further investigation through larger, randomized studies.

Lin Yang, Wang Lou, Yang Jiang et al.

Enhanced recovery after surgery (ERAS) is a multidisciplinary collaborative diagnosis and treatment model based on evidence-based medicine. By optimizing the perioperative management strategy, we can reduce the incidence of postoperative complications, minimize the physiological and psychological trauma stress reaction of patients, shorten the hospitalization period, and promote the functional recovery of patients. The diagnosis and treatment system integrates the advantages of surgery, anesthesiology, nursing, clinical nutrition and other disciplines, and constructs a whole process optimization path through preoperative evaluation, intraoperative management and postoperative rehabilitation, which fully embodies the patient-centered medical service concept. Postoperative pain, as a key factor affecting the rehabilitation process of patients, is closely related to the long-term quality of life of patients. Therefore, the optimization of pain management has become an indispensable and important part of eras. At present, multimodal analgesia (MMA) strategy has been widely recommended as the gold standard for postoperative pain management. This paper aims to review the latest research progress, clinical application strategies and future development direction of MMA in eras. It includes the theoretical basis, core drugs and technologies, application in different surgical fields, impact on patient prognosis, current challenges and future trends of MMA, and provides evidence-based basis for optimizing perioperative pain management.

Anne M. Beukers, Carolien S. E. Bulte, Ruben J. Bosch et al.

Abstract Background Acute microcirculatory perfusion disturbances and organ edema are important factors leading to organ dysfunction during cardiac surgery with cardiopulmonary bypass (CPB). Priming of the CPB system with crystalloid or colloid fluids, which inevitably leads to hemodilution, could contribute to this effect. However, there is yet no optimal evidence-based strategy for this type of priming. Hence, we will investigate different priming strategies to reduce hemodilution and preserve microcirculatory perfusion. Methods The PRIME study is a single-center double-blind randomized trial. Patients undergoing elective coronary artery bypass graft surgery with CPB will be randomized into three groups of prime fluid strategy: (1) gelofusine with crystalloid, (2) albumin with crystalloid, or (3) crystalloid and retrograde autologous priming. We aim to include 30 patients, 10 patients in each arm. The primary outcome is the change in microcirculatory perfusion. Secondary outcomes include colloid oncotic pressure; albumin; hematocrit; electrolytes; fluid balance and requirements; transfusion rates; and endothelial-, glycocalyx-, inflammatory- and renal injury markers. Sublingual microcirculatory perfusion will be measured using non-invasive sidestream dark field video microscopy. Microcirculatory and blood measurements will be performed at five consecutive time points during surgery up to 24 h after admission to the intensive care unit. Discussion PRIME is the first study to assess the effect of different prime fluid strategies on microcirculatory perfusion in cardiac surgery with CPB. If the results suggest that a specific crystalloid or colloid prime fluid strategy better preserves microcirculatory perfusion during on-pump cardiac surgery, the current study may help to find the optimal pump priming in cardiac surgery. Trial registration ClinicalTrials.gov NCT05647057. Registered on 04/25/2023. ClinicalTrials.gov PRS: Record Summary NCT05647057, all items can be found in the protocol.

René van Wyk, Ryan Alroy Davids

Abstract Background Drug administration errors (DAEs) in anaesthesia are common, the aetiology multifactorial and though mostly inconsequential, some lead to substantial harm. The extend of DAEs remain poorly quantified and effective implementation of prevention strategies sparse. Method A cross-sectional descriptive study was conducted using a peer-reviewed survey questionnaire, circulated to 2217 anaesthetists via a national communication platform. The aim was to determine the self-reported frequency, nature, contributing factors and reporting patterns of DAEs among anaesthesia providers in South Africa. Results Our cohort had a response rate was 18.9%, with 420 individuals populating the questionnaire. 92.5% of surveyed participants have made a DAE and 89.2% a near-miss. Incorrect route of administration, potentially resulting in serious harm, accounted for 8.2% (n = 23/N = 279) of these errors. DAEs mostly reported in cases involving adult patients (80.5%, n = 243/N = 302), receiving a general anaesthetic (71.8%, n = 216/N = 301), where the drug-administrator prepared the drugs themselves (78.7%, n = 218/N = 277), during normal daytime hours (69.9%, n = 202/N = 289) with good lightning conditions (93.0%, n = 265/N = 285). 26% (n = 80/N = 305) of DAEs involved ampoule misidentification, whilst syringe identification error reported in 51.6% (n = 150/N = 291) of cases. DAEs are often not reported (40.3%, n = 114/N = 283), with knowledge of correct reporting procedures lacking. 70.5% (n = 198/N = 281) of DAEs were never discussed with the patient. Conclusions DAEs in anaesthesia remain prevalent. Known error traps continue to drive these incidents. Implementation of system based preventative strategies are paramount to guard against human error. Efforts should be made to encourage scrupulous reporting and training of anaesthesia providers, with the aim of rendering them proficient and resilient to handle these events.

Mariateresa Giglio, Giacomo Farì, Angela Preziosa et al.

Abstract Chronic low back pain is often due to L5S1 instability resulting in facet joint syndrome. Patients suffering from low back pain may also have a gait pattern characterized by a reduced speed and a shorter, asymmetrical step in order to reduce pain. This case is of a patient with L5S1 instability that occurred after L1 to L5 lumbar stabilization who was treated with radiofrequency (RF) denervation of the medial branch of L5S1 bilaterally. RF ablation outcome was tested by comparing its impact on pain, function, quality of life, and on gait pattern, before and 1 month after the procedure. To objectify the impact of a good pain control on gait, a video recording was performed (see Video 1).

Ece Yamak Altinpulluk, Rajendra Kumar Sahoo , Felice Galluccio et al.

Shanshan Wang, Shanshan Wang, Taiga Ichinomiya et al.

Mitochondria play a crucial role in Alzheimer's disease (AD) onset and progression. Traditional transgenic AD mouse models which were widely used in the past decades share a common limitation: The overexpression of APP and overproduction of amyloid-beta (Aβ) are accompanied by other APP peptide fragments, which could introduce artificial and non-clinically relevant phenotypes. Here, we performed an in-depth and time-resolved behavioral and metabolic characterization of a clinically relevant AD mouse model engineered to express normal physiological levels of APP harboring humanized Swedish (K670N/M671L), Beyreuther/Iberian (I716F), and Arctic (E693G) mutations (AppNL−G−F/NL−G−F), termed APP knock-in (APPKI) mice. Our result showed that APPKI mice exhibited fear learning deficits at 6-m age and contextual memory deficit at 12-m age. Histopathological analysis revealed mild amyloidosis (6E10) accompanied by microgliosis (Iba1) as early as 3 months, which progressed significantly together with significant astrocytosis at 6 and 12 m. We further analyzed hippocampal mitochondrial dysfunction by multiple assays, while 3-m APPKI mice brain mitochondrial function remains a similar level as WT mice. Significant mitochondrial dysfunction characterized by decreased ATP production and higher membrane potential with subsequent overproduction of reactive oxygen species (ROS) was observed in mitochondria isolated from 7-m APPKI mice hippocampal tissue. Morphologically, these mitochondria were larger in volume with a decreased level of mitochondrial fusion protein mitofusin-2 (MFN2). At 12 months, APPKI mice exhibit a significantly decreased total mitochondrial oxygen consumption rate (OCR) in isolated hippocampal mitochondria detected by high-resolution respirometry. These data indicate early mitochondrial dysfunction in the brain at pre-symptomatic age in the AppNL−G−F/NL−G−mice, which may play a key role in the progression of the disease. Moreover, the identified behavioral and bioenergetic alterations in this clinically relevant AD mouse model provide a valuable tool to optimize the temporal component for therapeutic interventions to treat AD.

Lars Øivind Høiseth, Jørgen Melau, Martin Bonnevie-Svendsen et al.

Triathlon and other endurance races have grown in popularity. Although participants are generally fit and presumably healthy, there is measurable morbidity and mortality associated with participation. In triathlon, most deaths occur during the swim leg, and more insight into risk factors, such as hypothermia, is warranted. In this study, we measured the core temperature of 51 participants who ingested temperature sensor capsules before the swim leg of a full-distance triathlon. The water temperature was 14.4–16.4 °C, and the subjects wore wetsuits. One subject with a low body mass index and a long swim time experienced hypothermia (<35 °C). Among the remaining subjects, we found no association between core temperature and swim time, body mass index, or sex. To conclude, the present study indicates that during the swim leg of a full-distance triathlon in water temperatures ≈ 15–16 °C, subjects with a low body mass index and long swim times may be at risk of hypothermia even when wearing wetsuits.

Peter Mende-Siedlecki, Jennie Qu-Lee, Jingrun Lin et al.

Abstract. Introduction:. Facial expressions of pain serve an essential social function by communicating suffering and soliciting aid. Accurate visual perception of painful expressions is critical because the misperception of pain signals can have serious clinical and social consequences. Therefore, it is essential that researchers have access to high-quality, diverse databases of painful expressions to better understand accuracy and bias in pain perception. Objectives:. This article describes the development of a large-scale face stimulus database focusing on expressions of pain. Methods:. We collected and normed a database of images of models posing painful facial expressions. We also characterized these stimuli in terms of the presence of a series of pain-relevant facial action units. In addition to our primary database of posed expressions, we provide a separate database of computer-rendered expressions of pain that may be applied to any neutral face photograph. Results:. The resulting database comprises 229 unique (and now publicly available) painful expressions. To the best of our knowledge, there are no existing databases of this size, quality, or diversity in terms of race, gender, and expression intensity. We provide evidence for the reliability of expressions and evaluations of pain within these stimuli, as well as a full characterization of this set along dimensions relevant to pain such as perceived status, strength, and dominance. Moreover, our second database complements the primary set in terms of experimental control and precision. Conclusion:. These stimuli will facilitate reproducible research in both experimental and clinical domains into the mechanisms supporting accuracy and bias in pain perception and care.

Taku Nakagawa, Toshiharu Yasaka, Noriyuki Nakashima et al.

Abstract In the central nervous system, hyperpolarization-activated, cyclic nucleotide-gated (HCN1–4) channels have been implicated in neuronal excitability and synaptic transmission. It has been reported that HCN channels are expressed in the spinal cord, but knowledge about their physiological roles, as well as their distribution profiles, appear to be limited. We generated a transgenic mouse in which the expression of HCN4 can be reversibly knocked down using a genetic tetracycline-dependent switch and conducted genetically validated immunohistochemistry for HCN4. We found that the somata of HCN4-immunoreactive (IR) cells were largely restricted to the ventral part of the inner lamina II and lamina III. Many of these cells were either parvalbumin- or protein kinase Cγ (PKCγ)-IR. By using two different mouse strains in which reporters are expressed only in inhibitory neurons, we determined that the vast majority of HCN4-IR cells were excitatory neurons. Mechanical and thermal noxious stimulation did not induce c-Fos expression in HCN4-IR cells. PKCγ-neurons in this area are known to play a pivotal role in the polysynaptic pathway between tactile afferents and nociceptive projection cells that contributes to tactile allodynia. Therefore, pharmacological and/or genetic manipulations of HCN4-expressing neurons may provide a novel therapeutic strategy for the pain relief of tactile allodynia.

D. Singla, G. Chaudhry, J. Dureja et al.

Introduction Anxiety and pain are important and frequently encoun- tered issues in children especially during acute postope- rative period immediately after emergence from anae- sthesia. Additionally during ophthalmic surgical proce- dures, this is further compounded by inability to open one or both eyes post operatively. So, this study was planned to compare the efficacy of dexmedetomidine with midazolam used as intranasal premedication in children undergoing elective ophthalmic surgeries under general anaesthesia on post-operative analgesia, seda- tion and post-operative analgesic requirement. Materials and Methods 60 Children aged 3 to 10 years, American society of anaesthesia (ASA) class I or II posted for elective ophthalmic surgery under general anaesthesia were ran- domly allocated into two groups (group D and L). Chil- dren in-group D received Dexmedetomidine 1 μg/kg in- tranasally approximately 30 mins before the start of sur- gery. Children in-group M received intranasal midazo- lam 0.2 mg/kg approx. 30 mins before surgery. Results Children in group D had significantly lower values on objective pain scale when noted 1⁄2 hourly for first 2 hours post operatively. Likewise, Dexmedetomidine group has lower requirement of inj. Fentanyl. (07 doses in 06 children vs. 14 doses in 12 children) Conclusions Intra nasal dexmedetomidine premedication in children produced stable heart rate and systolic blood pressure during preoperative period and lowered the objective pain score with reduced analgesic requirement in post- operative period

Yutaka Oda, Takahisa Adachi, Ryushi Komatsu et al.

Abstract Background Although various agents are used during anesthesia for surgical resection of pheochromocytoma, application of desflurane has rarely been reported. We report the use of desflurane in a case receiving resection of extra-adrenal pheochromocytoma. Case presentation A 51-year-old female was transferred to our hospital for sustained hypertension. A diagnosis of extra-adrenal pheochromocytoma was made based on increased plasma catecholamine levels and radiographic findings. Surgical resection was planned after controlling blood pressure. General anesthesia was induced with propofol and fentanyl, followed by maintenance with desflurane 4.3% and remifentanil 0.2–0.4 μg/kg/min. Blood pressure and heart rate were stable during induction, tracheal intubation, and tumor manipulation. Blood pressure abruptly decreased to 62/40 mmHg after removal of the tumor, which was treated with noradrenaline. The surgery was completed uneventfully and the postoperative course was also uneventful. Conclusion Desflurane was safely used in combination with remifentanil during anesthesia for resection of extra-adrenal pheochromocytoma.

Mojtaba Mansouri, Gholamreza Masoumi, Samira Khalili

Background: This study aimed to determine the demand of maximum amount of blood in cardiac surgeries in Shahid Chamran hospital, Isfahan, Iran. Methods: In this cross-sectional study during 12012-2013, 1125 hospital records were studied. Information of blood bank included amounts and kind of reserved, crossmatched, and prescribed a blood, and transfusion indices were determined by the type of surgery. Findings: Amount of reserved pack cell was more than 3 time of consumed and only 34% of reserved pack cell was used for patients; the difference between reservation and consumption was significant. Crossmatched/transfused index (C/T) in most surgical procedures was not optimum (< 2.5); but transfusion index (TI) was desirable in all patients (1.01). Transfusion probability (T%) was statistically different based on the type of operation. Conclusion: Blood and product reservation was more than the required amount and led to wasting blood and products and increase in hospital costs. Thus, reservation of blood and its products must be calculated based on the type of surgery, and a practical protocol must be provided and implemented in all hospitals.

Shubin Wu, Weiyun Chen, Le Shen et al.

Abstract Severe hyperlactatemia (SH)/lactic acidosis (LA) after laparoscopic resection of pheochromocytoma is an infrequently reported complication. The study aims to investigate the incidence of this complication and to determine the clinical risk factors. Patients who underwent laparoscopic resection for pheochromocytoma between 2011 and 2014 at Peking Union Medical College Hospital were enrolled. LA was defined as pH < 7.35, bicarbonate <20 mmol/L, and serum lactate ≥5 mmol/L; SH as lactate ≥5 mmol/L; and moderate hyperlactatemia (MH) as lactate 2.5–5.0 mmol/L without evidence of acidosis (pH > 7.35 and/or bicarbonate >20 mmol/L). Data concerning patient demographics, clinical history, and laboratory results were collected and statistical analyses were performed. Out of 145 patients, 59 (40.7%) developed post-operative hyperlactatemia. The incidences of MH and SH/LA were 25.5% and 15.2%, respectively. Multivariate analysis demonstrated that body mass index (BMI) (odds ratio [OR], 1.204; 95% confidence interval [CI], 1.016–1.426), 24-hour urine epinephrine concentration (OR, 1.012; 95% CI, 1.002–1.022), and tumor size (OR, 1.571; 95% CI, 1.102–2.240) were independent predictors of post-operative SH/LA. The data show that post-operative SH/LA is not a rare complication after pheochromocytoma resection and may be closely associated with higher BMI, larger tumor size, and higher levels of urine epinephrine.

Seung Hoon Lee, Jung Eun Kim, Jong-Man Kang

A 28-year-old male patient with right maxillar, zygomatic arch, orbital wall, and nasal bone fractures had an orthognathic and nasal surgery. Naso-endotracheal intubation is the first choice during surgical correction of dentofacial deformities in an orthognathic surgery; however, its presence can interfere with concomitant surgical procedures on the nose. Traditionally, the naso-endotracheal tube will be removed and replaced with an oro-endotracheal tube. We changed the endotracheal tube from nasal to oral by using an airway exchange catheter.

Ingrid Muñoz, Nathalia Romero, Jose Andres Calvache

Introduction: Postoperative pain remains as a problem. National studies report incidences of 31% for moderate and 22% for severe pain. Inadequate analgesia is related to dissatisfaction and adverse outcomes. The aim of this study was to describe the incidence and characteristics of the postoperative pain in the post-anesthesia care unit (PACU) at Hospital Universitario San José of Popayán (HUSJ) in patients undergoing general anesthesia during the first postoperative hour. Methods: Cohort study. We recruited patients attending PACU and undergoing procedures using general anesthesia, between 18 and 70 years. Using a standardized collection form medical history, demographic data, medical history, anesthetic management, intraoperative analgesia and postoperative pain assessment by verbal and numerical pain scale (1-10) were recorded. Postoperative outcome data were also collected in the PACU. Results: The incidence of severe postoperative pain at 10 minutes was 12.3% 95%CI [7.1-18.2] (19 patients). Within 30 minutes of assessment 4.5% 95%CI [1.3-8.4] (7 patients) and 1.9% 60 minutes 95%CI [0-4.5] (3 patients). 48.7% required rescue analgesic at PACU. Incidence of postoperative nausea and vomiting (PONV) was significantly different in patients requiring rescue analgesic. Conclusion: The incidence of severe postoperative pain in the first postoperative hour at HUSJ is close to 12% and it decreases as time goes by. Patients requiring rescue analgesic have a higher incidence of postoperative complications such as PONV.

Mun Gyu Kim, Soon Im Kim, Si Young Ok et al.

BackgroundThe ultrasound-guided transverse abdominis plane block (TAPB) reduces postoperative pain after laparoscopic abdominal surgery. But, its effect post laparoscopic totally extraperitoneal hernia repair (TEP) is not clear. In this study, we evaluated the analgesic effect of ultrasound-guided TAPB in TEP.MethodsIn this prospective, randomized study, forty adult patients (ASA I-II) scheduled for a TEP under general anesthesia were studied. In the TAPB group (n = 20), an ultrasound-guided bilateral TAPB was performed with 0.375% ropivacaine 15 ml on each side after the induction of general anesthesia. The control group (n = 20) did not have TAPB performed. Fentanyl 50 µg was repeatedly injected as per the patient's request in the recovery room. Pain scores at rest and on coughing were assessed postoperatively in the recovery room (20 min, at discharge) and at 4, 8, and 24 hours after surgery.ResultsIn the recovery room, pain scores (numeric rating scale, 0-10) at postoperative 20 min were lower in the TAPB group (3.9 ± 1.6, 4.9 ± 1.8) than the control group (6.9 ± 1.6, 8.0 ± 1.6) at rest and on coughing. Also, pain scores upon discharge from the recovery room were lower in the TAPB group (3.2 ± 1.2, 4.2 ± 1.5) than the control group (5.3 ± 1.6, 6.5 ± 1.8) at rest and on coughing.ConclusionsThe ultrasound-guided TAPB in patients that had undergone TEP reduced postoperative pain scores and the fentanyl requirement in the recovery room. Also, pain scores on coughing were reduced until postoperative 8 hours.

Erdem Nail Duman, Sedat Saylan, Bahanur Cekic

JUSTIFICATIVA E OBJETIVOS: Trombastenia de Glanzmann (TG) é uma doença autossômica recessivamente hereditária das plaquetas. Não há nenhum tratamento específico. A transfusão de plaquetas é atualmente o tratamento padrão quando o sangramento não responde a medidas locais e/ou a medicamentos antifibrinolíticos, podendo, entretanto, resultar em aloimunização. O fator VII recombinante ativado (rFVIIa) pode ser usado para evitar a transfusão recorrente de plaquetas. RELATO DE CASO: Apresentamos um tratamento precoce com dose baixa de rFVIIa associada à transfusão de plaquetas em um caso pediátrico (cinco anos de idade), com diagnóstico de TG e apresentando sangramento prolongado durante adenoidectomia eletiva. Uma dose total de 1.200 mg (60 µg.kg-1) de rFVIIa obteve sucesso em estancar o sangramento, o que pode ser aceito como uma dose baixa. CONCLUSÕES: Relatos de casos podem encorajar o uso de tratamento precoce com baixas doses de rFVIIa em hemorragias graves que não estacam a despeito da transfusão de plaquetas e na prevenção de sangramento em procedimentos cirúrgicos em pacientes com TG. Estudos adicionais são necessários para definir a dose mínima eficaz. Portanto, as tentativas para determinar a dose eficaz mais baixa desse composto devem ser incentivadas consideando o resultado deste caso em face de restrições financeiras no sistema de saúde.

Ana Teresa Echevarría Hernández, Yamila Autié Castro, tia Hernández Domínguez et al.

<p><span style="font-family: Verdana; font-size: small;"><strong>Introducción: </strong>Las dificultades en el abordaje de la vía aérea es hoy, la primera causa de paro cardíaco en anestesiay responsables de 50 % de las complicaciones severas no fatales de causa anestésica. <strong></strong></span></p><p><span style="font-family: Verdana; font-size: small;"><strong>Objetivos: </strong>Identificar la capacidad de diferentes pruebas para la predicción del grado de dificultad a la intubación. <strong></strong></span></p><p><span style="font-family: Verdana; font-size: small;"><strong>Método:</strong> Se realizó un estudio observacional, analítico, de corte transversal, en pacientes programados para procedimientos quirúrgicos electivos con anestesia general orotraqueal en el HMC "Dr. Luis Díaz Soto" durante el año 2007. Los pacientes se dividieron aleatoriamente en dos grupos. Al grupo I se le realizó la prueba de Mallampati solamente, mientras que a los del grupo II se les aplicó además, la medición de la distancia tiromentoniana, distancia interincisivos, protrusión mandibular y extensión de la articulación atlanto-occipital clasificándolos como intubación fácil o difícil. Las variables analizadas fueron edad, índice de masa corporal, sexo y se correlacionó con las diferentes pruebas predictivas, así como la clasificación de Cormack y Lehane para determinar el grado de dificultad a la intubación por laringoscopía directa. <strong></strong></span></p><p><span style="font-family: Verdana; font-size: small;"><strong>Resultados:</strong> Ambos grupos fueron similares en cuanto a características antropométricas. Se encontró que el valor predictivo de la prueba de Mallampati modificado mejoró al combinarse con el resto de las pruebas pronósticas, teniendo la asociación de todos mayor sensibilidad, especificidad, valores predictivos positivo y negativo. <strong></strong></span></p><p><span style="font-family: Verdana; font-size: small;"><strong>Conclusiones:</strong> La asociación de varias pruebas y su correlación tienen una mejor capacidad para predecir el grado de dificultad con respecto al Mallampati solamente. </span></p>