Classification according to Cormack and Lehane

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Such a view during laryngoscopy corresponds to Cormack / Lehane grade I.

The Cormack and Lehane classification describes the direct visibility of elements of the larynx , especially the glottis , under conventional laryngoscopy during endotracheal intubation . No external pressure is exerted on the larynx using the Sellick handle or BURP maneuver .

The classification proposed by Cormack and Lehane in 1984 distinguishes four grades. With these, the degree of difficulty of intubation increases:

  • I: entire glottis adjustable
  • II: glottis partially visible (posterior commissure)
  • III: glottis not adjustable, only epiglottis (epiglottis) visible
  • IV: the epiglottis cannot be adjusted either, only the base of the tongue visible

Cook et al. suggested in 1996 a division of the 2nd degree into 2a and 2b for better comparability. Yentis and Lee published the modified classification with this graduation in 1998. The most recent modification was released by Cook in 2000. Here, the 3rd degree is also differentiated into "a" and "b":

  • I: entire glottis adjustable
  • II: glottis or posterior structures of this partially visible (posterior commissure)
    • IIa: glottis partially visible
    • IIb: Ary cartilage or posterior structures of the glottis (without view of the vocal cords) can be shown
  • III: glottis not adjustable, only epiglottis (epiglottis) visible
    • IIIa: Erect the epiglottis through a laryngoscope or guide rod (e.g. bougie)
    • IIIb: Epiglottis cannot be straightened up by manipulation
  • IV: the epiglottis cannot be adjusted either, only the base of the tongue visible

The correlation of these grades with preoperative evidence of difficult intubation, particularly the Mallampati classification , is not very high. No more than half of these cases can be detected prior to anesthesia.

See also

Individual evidence

  1. ↑ RS Cormack, J. Lehane: Difficult tracheal intubation in obstetrics. In: Anaesthesia. 39 (11), Nov 1984, pp. 1105-1111. PMID 6507827
  2. ↑ TM Cook: Cricoid pressure: are two hands better than one? In: Anaesthesia . tape 51 , no. 4 , April 1996, ISSN  0003-2409 , pp. 365-368 , doi : 10.1111 / j.1365-2044.1996.tb07750.x ( wiley.com [accessed January 15, 2020]).
  3. ↑ SM Yentis, DJH Lee: Evaluation of an improved scoring system for the grading of direct laryngoscopy . In: Anaesthesia . tape 53 , no. November 11 , 1998, ISSN  0003-2409 , pp. 1041-1044 , doi : 10.1046 / j.1365-2044.1998.00605.x ( wiley.com [accessed January 15, 2020]).
  4. ^ TM Cook: A new practical classification of laryngeal view . In: Anaesthesia . tape 55 , no. 3 , March 2000, p. 274-279 , doi : 10.1046 / j.1365-2044.2000.01270.x ( wiley.com [accessed January 15, 2020]).
  5. ↑ H. Langenstein, G. Cunitz: The difficult intubation in adults. In: Anaesthesiologist. 45 (4), Apr 1996, pp. 372-383. Review. PMID 8702056