Prediction of Ease of Laryngoscopy and Intubation-Role of Upper Lip Bite Test, Modified Mallampati Classification, and Thyromental Distance in Various Combination
Identifieur interne : 003133 ( Pmc/Curation ); précédent : 003132; suivant : 003134Prediction 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>
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<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>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Family Med Prim Care</journal-id>
<journal-id journal-id-type="iso-abbrev">J Family Med Prim Care</journal-id>
<journal-id journal-id-type="publisher-id">JFMPC</journal-id>
<journal-title-group><journal-title>Journal of Family Medicine and Primary Care</journal-title>
</journal-title-group>
<issn pub-type="ppub">2249-4863</issn>
<issn pub-type="epub">2278-7135</issn>
<publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name>
<publisher-loc>India</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">25810998</article-id>
<article-id pub-id-type="pmc">4366978</article-id>
<article-id pub-id-type="publisher-id">JFMPC-4-101</article-id>
<article-id pub-id-type="doi">10.4103/2249-4863.152264</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Prediction of Ease of Laryngoscopy and Intubation-Role of Upper Lip Bite Test, Modified Mallampati Classification, and Thyromental Distance in Various Combination</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Wajekar</surname>
<given-names>Anjana S.</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chellam</surname>
<given-names>Shrividya</given-names>
</name>
<xref ref-type="aff" rid="aff2">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Toal</surname>
<given-names>Pratibha V.</given-names>
</name>
<xref ref-type="aff" rid="aff2">1</xref>
</contrib>
</contrib-group>
<aff id="aff1"><italic>Bhabha Atomic Centre, King Edward Memorial Hospital, Mumbai, India</italic>
</aff>
<aff id="aff2"><label>1</label>
<italic>Department of Anaesthesia, Bhabha Atomic Research Centre Hospital, Mumbai, Maharashtra, India</italic>
</aff>
<author-notes><corresp id="cor1"><bold>Address for correspondence:</bold>
Dr. Anjana S. Wajekar, ‘Shri Niwas’, Plot no 62/7, Sector 28, Vashi, Navi Mumbai-400 703, Maharashtra, India. E-mail: <email xlink:href="anjanawajekar@gmail.com">anjanawajekar@gmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><season>Jan-Mar</season>
<year>2015</year>
</pub-date>
<volume>4</volume>
<issue>1</issue>
<fpage>101</fpage>
<lpage>105</lpage>
<permissions><copyright-statement>Copyright: © Journal of Family Medicine and Primary Care</copyright-statement>
<copyright-year>2015</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><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>
</abstract>
<kwd-group><kwd>Difficult airway</kwd>
<kwd>Mallampati classification</kwd>
<kwd>thyromental distance</kwd>
<kwd>upper lip bite test</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>
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