Comparison of Two Methods for Predicting Difficult Intubation †

Background:Patients undergoing coronary artery bypass graft (CABG) procedures have higher incidence of difficult laryngoscopy and intubation than general surgery population. Accurate prediction of difficult laryngoscopy in CABG patients is desirable to reduce the hemodynamic response and myocardial oxygen requirements. Recently, thyromental height test (TMHT) has been proposed as one of the highly sensitive and specific bedside tests to predict difficult airway. We, in our prospective observational study, evaluated the accuracy of the TMHT in predicting difficult laryngoscopy.Methodology:A total of 345 patients undergoing CABG of either sex, in the age group of 35–80 years, American Society of Anesthesiologists 111, undergoing CABG, were studied. Airway assessment was performed with modified Mallampati test with the addition of thyromental distance, sternomental distance, and TMHT. Intraoperatively, direct laryngoscopy was done in accordance with Cormack and Lehane grade of laryngoscopy. The preoperative data and laryngoscopic findings were used together to evaluate the accuracy of TMHT. The sensitivity, specificity, positive and negative predictive values of other three tests were calculated according to standard formula.Results:A total of 345 patients were in the group with mean age of study population at 56.7 (standard deviation 9.1) years (35–80 years). This study showed that almost all tests had good specificity, but sensitivity was poor. However, sensitivity of TMHT was 75% with accuracy of 95%. Receiver operating characteristic curve analysis of TMHT-derived cutoff was 52.17 which increased sensitivity to 81.25% and specificity to 92.3%.Conclusion:TMHT had a higher sensitivity compared to other tests along with good positive and negative predictive value and a very high specificity.

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“…Oates et al . [10] and Iohom et al . [7] also found the sensitivity of Mallampati test to be 42% and 43%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Thyromental height test for prediction of difficult laryngoscopy in patients undergoing coronary artery bypass graft surgical procedure

2017

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“…Unfortunately, most of these have low sensitivity and specificity. [567] By examining features specific to a sub-population of patients, improved sensitivity of the test may be achieved. [4] About 50% of the diabetic patients undergo surgery sometime during their life.…”

Section: Introductionmentioning

confidence: 99%

Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices

Hashim¹,

Thomas²

2014

Indian J Anaesth

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Background and Aims:Diabetic patients are prone for the limited joint mobility syndrome. The atlanto-occipital joint involvement limits adequate extension of head and neck during laryngoscopy making intubation difficult. The collagen glycosylation starts in the fourth and fifth inter-phalangeal joints. The degree of inter-phalangeal involvement can be assessed by scoring the ink impression made by the palm of the dominant hand (palm print [PP] sign) The aim of our study was to evaluate the PP sign as a screening tool for predicting difficult laryngoscopy in diabetic patients.Methods:A total of 60 diabetic patients undergoing general anaesthesia with endotracheal intubation were assessed pre-operatively for their airway indices using the modified Mallampati test, thyromental distance, degree of head extension, the PP test and the prayer sign and their corresponding Cormack–Lehane scores were noted. Statistical analysis was performed using Fischer exact test.Results:Of the 60 patients, 15 had positive PP sign. Of the 13 difficult laryngoscopies encountered, 10 patients had a positive PP sign. PP sign was the most sensitive index in predicting difficult laryngoscopy. P =0.000 was obtained and considered as statistically significant. The sensitivity was 76.9%, specificity 89.4%, positive and negative predictive value 71.4% and 91.3% and accuracy 86.7%, respectively. The other signs were not significant in predicting difficult laryngoscopy.Conclusion:The PP test appears to be the most sensitive and specific in the prediction of difficult laryngoscopy in diabetic patients.

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“…[7] Several investigation explain prediction schemes by applying a single risk factor or a multifactorial index. [89] One test for difficult laryngoscopy is the upper-lip-bite test (ULBT), assesses the possibility of a patient to cover the mucosa of the upper lip with the lower incisors. Grade 1 (the lower incisors can completely cover the upper lip's mucosa) and Grade 2 (the lower incisors can touch the upper lip but cannot completely cover the mucosa) are considered to predict easy laryngoscopy and are compared with Grade 3 of the ULBT (the lower incisors fail to bite the upper lip), which was noticed to be associated with difficult laryngoscopy.…”

Section: Introductionmentioning

confidence: 99%

A comparison of between hyomental distance ratios, ratio of height to thyromental, modified Mallamapati classification test and upper lip bite test in predicting difficult laryngoscopy of patients undergoing general anesthesia

2014

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Background:Failed intubation is imperative source of anesthetic interrelated patient's mortality. The aim of this present study was to compare the ability to predict difficult visualization of the larynx from the following pre-operative airway predictive indices, in isolation and combination: Modified Mallampati test (MMT), the ratio of height to thyromental distance (RHTMD), hyomental distance ratios (HMDR), and the upper-lip-bite test (ULBT).Materials and Methods:We collected data on 525 consecutive patients scheduled for elective surgery under general anesthesia requiring endotracheal intubation and then evaluated all four factors before surgery. A skilled anesthesiologist, not imparted of the noted pre-operative airway assessment, did the laryngoscopy and rating (as per Cormack and Lehane's classification). Sensitivity, specificity, and positive predictive value for every airway predictor in isolation and in combination were established.Results:The most sensitive of the single tests was ULBT with a sensitivity of 90.2%. The hyomental distance extreme of head extension was the least sensitive of the single tests with a sensitivity of 56.9. The HMDR had sensitivity 86.3%. The ULBT had the highest negative predictive value: And the area under a receiver-operating characteristic curve (AUC of ROC curve) among single predictors. The AUC of ROC curve for ULBT, HMDR and RHTMD was significantly more than for MMT (P < 0.05). No significant difference was noted in the AUC of ROC curve for ULBT, HMDR, and RHTMD (P > 0.05).Conclusion:The HMDR is comparable with RHTMD and ULBT for prediction of difficult laryngoscopy in the general population, but was significantly more than for MMT.

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Comparison of Two Methods for Predicting Difficult Intubation †

Cited by 201 publications

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Thyromental height test for prediction of difficult laryngoscopy in patients undergoing coronary artery bypass graft surgical procedure

Thyromental height test for prediction of difficult laryngoscopy in patients undergoing coronary artery bypass graft surgical procedure

Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices

A comparison of between hyomental distance ratios, ratio of height to thyromental, modified Mallamapati classification test and upper lip bite test in predicting difficult laryngoscopy of patients undergoing general anesthesia

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