Predicting difficult laryngoscopy in acromegalic patients undergoing surgery for excision of pituitary tumors: A comparison of extended Mallampati score with modified Mallampati classification
Identifieur interne : 002299 ( Main/Exploration ); précédent : 002298; suivant : 002300Predicting difficult laryngoscopy in acromegalic patients undergoing surgery for excision of pituitary tumors: A comparison of extended Mallampati score with modified Mallampati classification
Auteurs : Ashish Bindra [Inde] ; Hemanshu Prabhakar [Inde] ; Parmod K. Bithal [Inde] ; Gyaninder Pal Singh [Inde] ; Tumul Chowdhury [Inde]Source :
- Journal of Anaesthesiology, Clinical Pharmacology [ 0970-9185 ] ; 2013.
Abstract
There are numerous reports of difficult laryngoscopy and intubation in patients with acromegaly. To date, no study has assessed the application of extended Mallampati score (EMS) for predicting difficult intubation in acromegalics. The primary aim of this study was to compare EMS with modified Mallampati classification (MMP) in predicting difficult laryngoscopy in acromegalic patients. We hypothesized that since EMS has been reported to be more specific and better predictor than MMP, it may be superior to the MMP to predict difficult laryngoscopy in acromegalic patients.
For this prospective cohort study with matched controls, acromegalic patients scheduled to undergo pituitary surgery over a period of 3 years (January 2008-December 2010) were enrolled. Preoperative airway assessment was performed by experienced anesthesiologists and involved a MMP and the EMS. Under anesthesia, laryngoscopic view was assessed using Cormack-Lehane (CL) grading. MMP and CL grades of I and II were defined “easy” and III and IV as “difficult”. EMS grade of I and II were defined “easy” and III as “difficult”. Data were used to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MMP and EMS in predicting difficult laryngoscopy.
Seventy eight patients participated in the study (39 patients in each group). Both MMP and EMS failed to detect difficult laryngoscopy in seven patients. Only one laryngoscopy was predicted to be difficult by both tests which was in fact, difficult.
We found that addition of neck extension did not improve the predictive value of MMP.
Url:
DOI: 10.4103/0970-9185.111694
PubMed: 23878439
PubMed Central: 3713665
Affiliations:
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Bithal</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi</wicri:regionArea><wicri:noRegion>New Delhi</wicri:noRegion></affiliation></author><author><name sortKey="Singh, Gyaninder Pal" sort="Singh, Gyaninder Pal" uniqKey="Singh G" first="Gyaninder Pal" last="Singh">Gyaninder Pal Singh</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi</wicri:regionArea><wicri:noRegion>New Delhi</wicri:noRegion></affiliation></author><author><name sortKey="Chowdhury, Tumul" sort="Chowdhury, Tumul" uniqKey="Chowdhury T" first="Tumul" last="Chowdhury">Tumul Chowdhury</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi</wicri:regionArea><wicri:noRegion>New Delhi</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of Anaesthesiology, Clinical Pharmacology</title><idno type="ISSN">0970-9185</idno><idno type="eISSN">2231-2730</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title><p>There are numerous reports of difficult laryngoscopy and intubation in patients with acromegaly. To date, no study has assessed the application of extended Mallampati score (EMS) for predicting difficult intubation in acromegalics. The primary aim of this study was to compare EMS with modified Mallampati classification (MMP) in predicting difficult laryngoscopy in acromegalic patients. We hypothesized that since EMS has been reported to be more specific and better predictor than MMP, it may be superior to the MMP to predict difficult laryngoscopy in acromegalic patients.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>For this prospective cohort study with matched controls, acromegalic patients scheduled to undergo pituitary surgery over a period of 3 years (January 2008-December 2010) were enrolled. Preoperative airway assessment was performed by experienced anesthesiologists and involved a MMP and the EMS. Under anesthesia, laryngoscopic view was assessed using Cormack-Lehane (CL) grading. MMP and CL grades of I and II were defined “easy” and III and IV as “difficult”. EMS grade of I and II were defined “easy” and III as “difficult”. Data were used to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MMP and EMS in predicting difficult laryngoscopy.</p></sec><sec id="st3"><title>Results:</title><p>Seventy eight patients participated in the study (39 patients in each group). Both MMP and EMS failed to detect difficult laryngoscopy in seven patients. Only one laryngoscopy was predicted to be difficult by both tests which was in fact, difficult.</p></sec><sec id="st4"><title>Conclusion:</title><p>We found that addition of neck extension did not improve the predictive value of MMP.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Samsoon, Gl" uniqKey="Samsoon G">GL Samsoon</name></author><author><name sortKey="Young, Jr" uniqKey="Young J">JR Young</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schmitt, H" uniqKey="Schmitt H">H Schmitt</name></author><author><name sortKey="Buchfelder, M" uniqKey="Buchfelder M">M Buchfelder</name></author><author><name sortKey="Radespiel Troger, M" uniqKey="Radespiel Troger M">M Radespiel-Tröger</name></author><author><name sortKey="Fahlbusch, R" uniqKey="Fahlbusch R">R Fahlbusch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lewis, M" uniqKey="Lewis M">M 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Ali</name></author><author><name sortKey="Singh, Gp" uniqKey="Singh G">GP Singh</name></author><author><name sortKey="Rath, Gp" uniqKey="Rath G">GP Rath</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Inde</li></country></list><tree><country name="Inde"><noRegion><name sortKey="Bindra, Ashish" sort="Bindra, Ashish" uniqKey="Bindra A" first="Ashish" last="Bindra">Ashish Bindra</name></noRegion><name sortKey="Bithal, Parmod K" sort="Bithal, Parmod K" uniqKey="Bithal P" first="Parmod K" last="Bithal">Parmod K. Bithal</name><name sortKey="Chowdhury, Tumul" sort="Chowdhury, Tumul" uniqKey="Chowdhury T" first="Tumul" last="Chowdhury">Tumul Chowdhury</name><name sortKey="Prabhakar, Hemanshu" sort="Prabhakar, Hemanshu" uniqKey="Prabhakar H" first="Hemanshu" last="Prabhakar">Hemanshu Prabhakar</name><name sortKey="Singh, Gyaninder Pal" sort="Singh, Gyaninder Pal" uniqKey="Singh G" first="Gyaninder Pal" last="Singh">Gyaninder Pal Singh</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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