Prediction of Ease of Laryngoscopy and Intubation-Role of Upper Lip Bite Test, Modified Mallampati Classification, and Thyromental Distance in Various Combination
Identifieur interne : 005977 ( Ncbi/Curation ); précédent : 005976; suivant : 005978Prediction of Ease of Laryngoscopy and Intubation-Role of Upper Lip Bite Test, Modified Mallampati Classification, and Thyromental Distance in Various Combination
Auteurs : Anjana S. Wajekar ; Shrividya Chellam ; Pratibha V. ToalSource :
- Journal of Family Medicine and Primary Care [ 2249-4863 ] ; 2015.
Abstract
The incidence of difficult intubation in patients undergoing general anaesthesia is estimated to be approximately 1-18% whereas that of failure to intubate is 0.05-0.35%.1,2,3 Various methods have been used for prediction of difficult laryngoscopy. Although, upper lip bite has been shown to be a promising test in its introductory article, repeated validation in various populations is required for any test to be accepted as a routine test. We have compared upper lip bite test (ULBT), modified Mallampati test (MMC) and thyromental distance (TMD) individually and in various combinations to verify which of these predictor tests are significantly associated with difficult glottic exposure.
After obtaining institutional ethics committee approval, 402 ASA I and II adult patients undergoing elective surgical procedures requiring endotracheal intubation were included. All the three test were performed in all the patients preoperatively and their glottic exposure was recorded by Cormack-Lehane classification during intubation. Sensitivity, specificity, positive predictive value and negative predictive value were used for comparison.
In our study, the incidence of difficult laryngoscopy was 11.4% and failure to intubate 0.49%. None of the three are a suitable predictive test when used alone. Combination of tests added incremental diagnostic value.
We conclude that all three screening tests for difficult intubation have only poor to moderate discriminative power when used alone. Combinations of individual tests add some incremental diagnostic value.
Url:
DOI: 10.4103/2249-4863.152264
PubMed: 25810998
PubMed Central: 4366978
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<author><name sortKey="Wajekar, Anjana S" sort="Wajekar, Anjana S" uniqKey="Wajekar A" first="Anjana S." last="Wajekar">Anjana S. Wajekar</name>
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<author><name sortKey="Chellam, Shrividya" sort="Chellam, Shrividya" uniqKey="Chellam S" first="Shrividya" last="Chellam">Shrividya Chellam</name>
<affiliation><nlm:aff id="aff2"><italic>Department of Anaesthesia, Bhabha Atomic Research Centre Hospital, Mumbai, Maharashtra, India</italic>
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<author><name sortKey="Toal, Pratibha V" sort="Toal, Pratibha V" uniqKey="Toal P" first="Pratibha V." last="Toal">Pratibha V. Toal</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prediction of Ease of Laryngoscopy and Intubation-Role of Upper Lip Bite Test, Modified Mallampati Classification, and Thyromental Distance in Various Combination</title>
<author><name sortKey="Wajekar, Anjana S" sort="Wajekar, Anjana S" uniqKey="Wajekar A" first="Anjana S." last="Wajekar">Anjana S. Wajekar</name>
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<author><name sortKey="Chellam, Shrividya" sort="Chellam, Shrividya" uniqKey="Chellam S" first="Shrividya" last="Chellam">Shrividya Chellam</name>
<affiliation><nlm:aff id="aff2"><italic>Department of Anaesthesia, Bhabha Atomic Research Centre Hospital, Mumbai, Maharashtra, India</italic>
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<author><name sortKey="Toal, Pratibha V" sort="Toal, Pratibha V" uniqKey="Toal P" first="Pratibha V." last="Toal">Pratibha V. Toal</name>
<affiliation><nlm:aff id="aff2"><italic>Department of Anaesthesia, Bhabha Atomic Research Centre Hospital, Mumbai, Maharashtra, India</italic>
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<series><title level="j">Journal of Family Medicine and Primary Care</title>
<idno type="ISSN">2249-4863</idno>
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<front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title>
<p>The incidence of difficult intubation in patients undergoing general anaesthesia is estimated to be approximately 1-18% whereas that of failure to intubate is 0.05-0.35%.1,2,3 Various methods have been used for prediction of difficult laryngoscopy. Although, upper lip bite has been shown to be a promising test in its introductory article, repeated validation in various populations is required for any test to be accepted as a routine test. We have compared upper lip bite test (ULBT), modified Mallampati test (MMC) and thyromental distance (TMD) individually and in various combinations to verify which of these predictor tests are significantly associated with difficult glottic exposure.</p>
</sec>
<sec id="st2"><title>Methods:</title>
<p>After obtaining institutional ethics committee approval, 402 ASA I and II adult patients undergoing elective surgical procedures requiring endotracheal intubation were included. All the three test were performed in all the patients preoperatively and their glottic exposure was recorded by Cormack-Lehane classification during intubation. Sensitivity, specificity, positive predictive value and negative predictive value were used for comparison.</p>
</sec>
<sec id="st3"><title>Results:</title>
<p>In our study, the incidence of difficult laryngoscopy was 11.4% and failure to intubate 0.49%. None of the three are a suitable predictive test when used alone. Combination of tests added incremental diagnostic value.</p>
</sec>
<sec id="st4"><title>Conclusion:</title>
<p>We conclude that all three screening tests for difficult intubation have only poor to moderate discriminative power when used alone. Combinations of individual tests add some incremental diagnostic value.</p>
</sec>
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