A Comparison of the Mallampati evaluation in neutral or extended cervical spine positions: a retrospective observational study of 80 000 patients

Healy, David W.; Peoples, Emily; Jewell, Edward; Bettendorf, R.J.; Ramachandran, Satya Krishna; Kleine‐Brueggeney, Maren; Greif, Robert; Schoettker, Patrick; Savoldelli, G.; Nabecker, Sabine; Theiler, Lorenz

doi:10.1093/bja/aew272

Cited by 6 publications

(6 citation statements)

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“…). After detailed assessment, we included 133 studies (127 cohort type and six case–control) involving 844,206 participants . Of the 133 studies, there were six for the Mallampati test, 105 for the modified Mallampati test, six for Wilson risk score, 52 for thyromental distance, 18 for sternomental distance, 34 for the mouth opening test and 30 for the upper lip bite test.…”

Section: Resultsmentioning

confidence: 99%

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

et al. 2019

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Although bedside screening tests are routinely used to identify people at high risk of having a difficult airway, their clinical utility is unclear. We estimated the diagnostic accuracy of commonly used bedside examination tests for assessing the airway in adult patients without apparent anatomical abnormalities scheduled to undergo general anaesthesia. We searched for studies that reported our pre-specified bedside index screening tests against a reference standard, published in any language, from date of inception to 16 December 2016, in seven bibliographic databases. We included 133 studies (127 cohort type and 6 case-control) involving 844,206 participants. Overall, their methodological quality (according to QUADAS-2, a standard tool for assessing quality of diagnostic accuracy studies) was moderate to high. Our pre-specified tests were: the Mallampati test (6 studies); modified Mallampati test (105 studies); Wilson risk score (6 studies); thyromental distance (52 studies); sternomental distance (18 studies); mouth opening test (34 studies); and the upper lip bite test (30 studies). Difficult facemask ventilation, difficult laryngoscopy, difficult intubation and failed intubation were the reference standards in seven, 92, 50 and two studies, respectively. Across all reference standards, we found all index tests had relatively low sensitivities, with high variability, but specificities were consistently and markedly higher than sensitivities. For difficult laryngoscopy, the sensitivity and specificity (95%CI) of the upper lip bite test were 0.67 (0.45-0.83) and 0.92 (0.86-0.95), respectively; upper lip bite test sensitivity (95%CI) was significantly higher than that for the mouth opening test (0.22, 0.13-0.33; p < 0.001). For difficult tracheal intubation, the modified Mallampati test had a significantly higher sensitivity (95%CI) at 0.51 (0.40-0.61) compared with mouth opening (0.27, 0.16-0.41; p < 0.001) and thyromental distance (0.24, 0.12-0.43; p < 0.001). Although the upper lip bite test showed the most favourable diagnostic test accuracy properties, none of the common bedside screening tests is well suited for detecting unanticipated difficult airways, as many of them are missed.

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Section: Resultsmentioning

confidence: 99%

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

et al. 2019

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“…22 If visual inspection or palpation fails to identify the CTM location with certainty, it should be identified using ultrasonography and marked, 22,23 with the patient's neck in an extended position. The patient can subsequently be positioned Table 1 Published predictors of difficult tracheal intubation using direct laryngoscopy Predictors of difficult laryngoscopy and tracheal intubation using direct laryngoscopy [11][12][13]16,[25][26][27][28][29][30][31] • Age [ 46 yr…”

Section: The Enhanced Airway Evaluationmentioning

confidence: 99%

“…Recommendations for the anticipated difficult airway DL or intubation. Whether obesity alone predicts difficult laryngoscopy/intubation continues to be controversial, with some studies reporting an association, 15,29,31,39,[192][193][194][195] and others not. 11,25,191,[196][197][198] No studies have yet reported obesity to be a risk factor for difficult or failed VLfacilitated tracheal intubation, although one study has reported a thick neck to be associated with failed HA-VLfacilitated tracheal intubation.…”

Section: Post-proceduresmentioning

confidence: 99%

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the published airway management literature has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This second of two articles addresses airway evaluation, decision-making, and safe implementation of an airway management strategy when difficulty is anticipated. Source Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence is lacking, statements are based on group consensus. Findings and key recommendations Prior to airway management, a documented strategy should be formulated for every patient, based on airway evaluation. Bedside examination should seek predictors of difficulty with face-mask ventilation (FMV), tracheal intubation using video- or direct laryngoscopy (VL or DL), supraglottic airway use, as well as emergency front of neck airway access. Patient physiology and contextual issues should also be assessed. Predicted difficulty should prompt careful decision-making on how most safely to proceed with airway management. Awake tracheal intubation may provide an extra margin of safety when impossible VL or DL is predicted, when difficulty is predicted with more than one mode of airway management (e.g., tracheal intubation and FMV), or when predicted difficulty coincides with significant physiologic or contextual issues. If managing the patient after the induction of general anesthesia despite predicted difficulty, team briefing should include triggers for moving from one technique to the next, expert assistance should be sourced, and required equipment should be present. Unanticipated difficulty with airway management can always occur, so the airway manager should have a strategy for difficulty occurring in every patient, and the institution must make difficult airway equipment readily available. Tracheal extubation of the at-risk patient must also be carefully planned, including assessment of the patient’s tolerance for withdrawal of airway support and whether re-intubation might be difficult.

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“…Although efforts have been made to find reliable predictive tests for difficult airways [12][13][14], these tests may frequently fail to predict the difficulty.…”

Section: Adequate Planningmentioning

confidence: 99%

Progress in difficult airway management

Asai

2017

J Anesth

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A Comparison of the Mallampati evaluation in neutral or extended cervical spine positions: a retrospective observational study of 80 000 patients

Abstract: These articles were published by mistake in the May 2016 issue of BJA due to an administrative error. They were supposed to go into this special issue on Airway Management. The articles can be accessed free of charge at the following link

Cited by 6 publications

References 0 publications

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Progress in difficult airway management

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