A comparison of Mallampati scoring, upper lip bite test and sternomental distance in predicting difficult intubation

Varghese, Arun; Mohamed, Taznim

doi:10.18203/2320-6012.ijrms20161925

Cited by 3 publications

(2 citation statements)

References 14 publications

(24 reference statements)

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“…One hundred seventy-eight papers used prospective design, twelve used retrospective design, eighteen papers used case–control design. Sixty-nine papers used blinded experiment [ 15 , 20 , 25 , 29 – 31 , 44 , 50 , 57 , 60 , 61 , 63 , 71 , 75 , 77 , 86 , 90 , 91 , 95 , 98 , 102 , 112 , 115 , 116 , 123 – 125 , 127 – 129 , 139 , 140 , 143 , 147 , 152 , 159 – 161 , 169 , 171 – 174 , 179 – 183 , 185 , 186 , 188 – 192 , 196 , 201 , 204 , 208 , 209 , 211 , 218 , 228 – 230 , 234 ]. Twenty-four specifically selected obese populations for research [ 36 , 39 , 40 , 43 , 59 , 61 , 65 , 70 , 86 , 99 , 106 , 109 , 121 ,…”

Section: Resultsmentioning

confidence: 99%

“…Almost all studies indicated that difficult tracheal intubation assessment was performed before surgery. Only 69 articles explicitly used blinded methods [ 15 , 20 , 25 , 29 – 31 , 44 , 50 , 57 , 60 , 61 , 63 , 71 , 75 , 77 , 86 , 90 , 91 , 95 , 98 , 102 , 112 , 115 , 116 , 123 – 125 , 127 – 129 , 139 , 140 , 143 , 147 , 152 , 159 – 161 , 169 , 171 – 174 , 179 – 183 , 185 , 186 , 188 – 192 , 196 , 201 , 204 , 208 , 209 , 211 , 218 , 228 – 230 , 234 ]. When assessing the risk of bias in 227 studies using the QUADAS-2 tool, 27 studies showed problems with patient selection, 10 studies showed problems with index testing, 49 studies showed problems with reference standards, and 33 studies showed problems with procedures and timing.…”

Section: Resultsmentioning

confidence: 99%

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Evaluation of preoperative difficult airway prediction methods for adult patients without obvious airway abnormalities: a systematic review and meta-analysis

Wang,

Jin,

Zheng

et al. 2024

BMC Anesthesiol

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Background This systematic review aims to assist clinical decision-making in selecting appropriate preoperative prediction methods for difficult tracheal intubation by identifying and synthesizing literature on these methods in adult patients undergoing all types of surgery. Methods A systematic review and meta-analysis were conducted following PRISMA guidelines. Comprehensive electronic searches across multiple databases were completed on March 28, 2023. Two researchers independently screened, selected studies, and extracted data. A total of 227 articles representing 526 studies were included and evaluated for bias using the QUADAS-2 tool. Meta-Disc software computed pooled sensitivity (SEN), specificity (SPC), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Heterogeneity was assessed using the Spearman correlation coefficient, Cochran’s-Q, and I2 index, with meta-regression exploring sources of heterogeneity. Publication bias was evaluated using Deeks’ funnel plot. Results Out of 2906 articles retrieved, 227 met the inclusion criteria, encompassing a total of 686,089 patients. The review examined 11 methods for predicting difficult tracheal intubation, categorized into physical examination, multivariate scoring system, and imaging test. The modified Mallampati test (MMT) showed a SEN of 0.39 and SPC of 0.86, while the thyromental distance (TMD) had a SEN of 0.38 and SPC of 0.83. The upper lip bite test (ULBT) presented a SEN of 0.52 and SPC of 0.84. Multivariate scoring systems like LEMON and Wilson’s risk score demonstrated moderate sensitivity and specificity. Imaging tests, particularly ultrasound-based methods such as the distance from the skin to the epiglottis (US-DSE), exhibited higher sensitivity (0.80) and specificity (0.77). Significant heterogeneity was identified across studies, influenced by factors such as sample size and study design. Conclusion No single preoperative prediction method shows clear superiority for predicting difficult tracheal intubation. The evidence supports a combined approach using multiple methods tailored to specific patient demographics and clinical contexts. Future research should focus on integrating advanced technologies like artificial intelligence and deep learning to improve predictive models. Standardizing testing procedures and establishing clear cut-off values are essential for enhancing prediction reliability and accuracy. Implementing a multi-modal predictive approach may reduce unanticipated difficult intubations, improving patient safety and outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Evaluation of preoperative difficult airway prediction methods for adult patients without obvious airway abnormalities: a systematic review and meta-analysis

Wang,

Jin,

Zheng

et al. 2024

BMC Anesthesiol

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Comparison Upper Lip Bite Test and Mallampati Test in the Prediction of Difficult Laryngoscopy

Fakhr¹,

Tarbiat²

2020

Avicenna J Clin Med

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Background and Objective: Intubation is the most common method for the management of the upper airway in general anesthesia. In this regard, the prediction of the ease or difficulty of intubation is of paramount importance for the anesthesia team. The main cause of anesthesia-related mortality is failed airway management. The present study aimed to compare the accuracy of the upper lip bite (ULBT) test and mallampati test in the fast prediction of difficult intubation. Materials and Methods: This descriptive-analytical study was conducted on 418 patients. Prior to anesthesia, the degree of difficulty of intubation was predicted using two predictive tests, namely Mallampati test and upper lip bite test. In addition, after anesthesia, the degree of predicted difficulty was compared with the Cormack-Lehane classification of laryngoscopic view. Results: As evidenced by the obtained results, the frequency of difficult intubation was reported as 5.3%. Sensitivity, specificity, and negative predictive value of ULBT test were measured at 21.4%, 95.3%, and 97.2%, respectively. Moreover, the accuracy was obtained at 92.8% which was the highest value. On the other hand, sensitivity, specificity, and negative predictive value of Mallampati test were estimated at 34.7%, 87.5%, and 91%, respectively. In addition, the accuracy of this was reported as 81.3%. Conclusion: The results of the current study indicated that ULBT test as an easy method with high specificity, high predictive value, and high accuracy in the evaluation and prediction of difficult laryngoscopy is more suitable than Mallamati.

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Prediction of Difficult Intubation by Using Upper Lip Bite, Thyromental Distance and Mallampati Score in Comparison to Cormack and Lehane Classification System

2021

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The aim: To evaluate efficacy of Modified Mallampati test (MMT), upper lip bite test (ULBT) and Thyromental distance (TMD) or combination of two method Modified Mallampati test (MMT)+ upper lip bite test (ULBT), Thyromental distance (TMD) + upper lip bite test (ULBT) in prediction of difficult intubation in patients undergoing GA. Materials and methods: Three tests were carried out in all patients by a single anesthesiologist. These were MMT, ULBT and TMD. Laryngoscopy was performed with patient’s head in the sniffing position. The laryngoscopy view was graded according to modified Cormack and Lehane classification system. Study was prospective, single cross sectional, in 151 adult patients who required GA with endotracheal intubation for elective surgery. On arrival in the operating room, routine monitoring and venous cannula were introduced. Midazolam, Fentanyl. and rocuronium, ketamine , propofol were given to facilitate endotracheal intubation. Results: Out of 150 assessed patients, 18 (12%) had difficult intubation. Of those 18 patients, 17 (83.33%) patients had Cormack and Lehane classification III and one patient (16.67%) had classification IV. Compared with Cormack and Lehane classification system as the gold standard for difficult intubation, the sensitivity and specificity of MMT was 66.67% and 96.97% respectively, while ULBT had a sensitivity of 77.78% and a specificity of 93.18%, and TMD had a sensitivity of 55.56% and specificity of 94.97% respectively. A combination of different tests improved their efficiencies. The sensitivity and specificity MMT and TMD combinations was 77.78% and 92.42% respectively, while it was 88.89% and 93.18%, respectively for MMT and ULPT. The combination of TMD and ULBT has a sensitivity of 88.33% and a specificity of 91.67%. Conclusions: Upper lip biting test has the best sensitivity while MMT had the best specificity. No single test alone can be reliable for predicting of difficult intubation. The combination of ULBT and MMT was the best in terms of both sensitivity and specificity for prediction of difficult intubation.

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A comparison of Mallampati scoring, upper lip bite test and sternomental distance in predicting difficult intubation

Cited by 3 publications

References 14 publications

Evaluation of preoperative difficult airway prediction methods for adult patients without obvious airway abnormalities: a systematic review and meta-analysis

Evaluation of preoperative difficult airway prediction methods for adult patients without obvious airway abnormalities: a systematic review and meta-analysis

Comparison Upper Lip Bite Test and Mallampati Test in the Prediction of Difficult Laryngoscopy

Prediction of Difficult Intubation by Using Upper Lip Bite, Thyromental Distance and Mallampati Score in Comparison to Cormack and Lehane Classification System

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