John Lehane

John Robert Lehane (1945-2018) was an English anaesthetist

Born in Merseyside to a medical family, his Father had a leading role in work for prevention of Rhesus haemolytic disease and hepatitis B and his sister was an anaesthetist who was part of the team that first identified the gene for malignant hyperthermia.

Co-authored a paper with Ronald Cormack in 1984 which formed the foundation of the Cormack-Lehane laryngoscopy grades. The paper has a citation score of >1600 making it one of the most quoted papers in science. Cormack and Lehane also advocated for practicing difficult intubation drills and techniques for when an unexpected difficult airway may arise.

Biography

• Born 1945
• 1969 – graduated from Liverpool University
• 1973 – FFARCS
• 1975 – MRCP
• 1978 – MRC unit at Northwick Park working alongside Ronald Cormack. Together they worked on a system of teaching students intubation in Obstetric patients. This resulted in their famous classification of the laryngeal view into the four grades.
• 1984 – Co-author of the Cormack-Lehane scoring system, a simple classification system for grading direct laryngoscopy in Anaesthesia
• 2013 – Macewen Medal from the Difficult Airway Society
• Died in November 2018

Medical Eponyms

Cormack-Lehane scoring system (1984)

Cormack and Lehane looked into previous research of maternal deaths in England and Wales; specifically looking into pulmonary aspiration. They found that difficult intubation was well known for certain diseases (e.g. ankolysing spondylitis) but it was not well documented why difficulty may arise in healthy patients.

They came up with the Cormack-Lehane grading system, a simple score for view obtained with direct laryngoscopy. This made it easy for beginners to describe what was likely to be an easy intubation (grade 1 and 2) or a difficult intubation (grade 3 and 4).

Classification describes the best view possible at laryngoscopy:

• Grade I: complete glottis visible
• Grade II: anterior glottis not seen
• Grade III: epiglottis seen, but not glottis
• Grade IV: epiglottis not seen

1998 – A modified version of grade II was developed by Yentis and Lee, subdividing II into 2a and 2b. Where 2a is partial view of the glottis and 2b is only the posterior aspect of the glottis or only the arytenoid cartilage.

Major Publications

• Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984; 39(11): 1105-1111.

References

Biography

• John Robert Lehane. DAS medal, 2013
• Maltby JR. Cormack-Lehane laryngoscopy grades. In: Notable Names in Anaesthesia. The Choir Press, 2013: 43-45

Eponymous terms

• Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study, Anaesthesia 1987; 42: 487
• Wilson ME et al. Predicting difficult intubation. Br J Anaesth. 1988; 61(2): 211-216.
• Bond A. Obesity and difficult intubation. Anaesth Intensive Care. 1993; 21(6): 828-830. Laryngoscopy technique. Anaesthesia UK
• Yentis SM, Lee DJ. Evaluation of an improved scoring system for the grading of direct laryngoscopy. Anaesthesia. 1998 Nov;53(11):1041-4
• Krage R, van Rijn C, van Groeningen D, Loer SA, Schwarte LA, Schober P. Cormack-Lehane classification revisited. Br J Anaesth. 2010; 105(2): 220-227
• Pearce AC, Duggan LV, El-Boghdadly K. Making the grade: has Cormack and Lehane grading stood the test of time? Anaesthesia. 2021; 76(5): 705-709 

Alex Johnson

Doctor currently working in South Wales, training in anaesthetics. Graduated Leeds University with MB ChB with BSc in microbiology in relation to medicine. Special interests in emergency medicine, critical care and anaesthetics

Mike Cadogan

Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |