title: Usefulness and diagnostic value of the NEMA parameter combined with other selected bedside tests for prediction of difficult intubation.
abstract: OBJECTIVE
  To assess the usefulness of the new NEMA (Neck Circumference Minus Acromion-Acromion Distance) parameter, in preoperative identification of patients' difficult intubation and compare it with other commonly used scales and tests.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  District Specialist Hospital of Lublin, Poland.
  
  
  METHODS
  Six hundreds twenty-nine patients underwent nonemergency surgical interventions.
  
  
  METHODS
  The NEMA parameter was confronted with: Modified Mallampati classification, TMD, RHTMD, NC, MPND, SMD, I-I D, A-AD, and medical history of difficult intubation and diagnosed obstructive sleep apnea syndrome or snoring.
  
  
  RESULTS
  Higher medians of NEMA and Mallampati parameters were reported in patients with difficult intubation. AUC for Mallampati parameter was 0.733 while the NEMA parameter's AUC was 0.625. Sensitivity and specificity for Mallampati and NEMA parameter were respectively 0.79; 0.55 and 0.42; 0.75. Significantly higher MPN, RHTMD, Mallampati, and NEMA parameter were observed in patients in whom the BURP was used. Easy intubation occurs more frequently in patients with a history of OSAS or snoring than in those with difficult intubation.
  
  
  CONCLUSIONS
  It seems that none of the known bedside tests for predicting difficult intubation have a discriminating power sufficient for clinicians. Our study draws attention to a novel parameter, called NEMA, which appears to be a strong predictor of DEI, especially in combination with the Mallampati scale.
authors.affiliation: Department of Didactics and Medical Simulation, Chair of Anatomy, Medical University of Lublin, Poland. Electronic address: kamiltorres@wp.pl.
authors.forename: Kamil
authors.initials: K
authors.lastname: Torres
authors.affiliation: Department of Anesthesiology and Intensive Care, District Specialist Hospital, Lublin, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Błoński
authors.affiliation: Department of Didactics and Medical Simulation, Chair of Anatomy, Medical University of Lublin, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Pietrzyk
authors.affiliation: Department of Anesthesiology and Intensive Care, District Specialist Hospital, Lublin, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Piasecka-Twaróg
authors.affiliation: Department of Human Anatomy, Chair of Anatomy, Medical University of Lublin, Poland.
authors.forename: Ryszard
authors.initials: R
authors.lastname: Maciejewski
authors.affiliation: Department of Human Anatomy, Chair of Anatomy, Medical University of Lublin, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Torres
mesh_terms: D000174:Acromion / Q000033:anatomy & histology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001837:Body Weights and Measures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications*; D012913:Snoring / Q000150:complications*; D055815:Young Adult
keywords: Airway management; Laryngoscopy; Risk assessment; Tracheal intubation