Diagnostic accuracy of bedside tests for predicting difficult intubation in Indian population: An observational study

Abstract

Background:Unanticipated difficult intubation can be challenging to anesthesiologists, and various bedside tests have been tried to predict difficult intubation.Aims:The aim of this study was to determine the incidence of difficult intubation in the Indian population and also to determine the diagnostic accuracy of bedside tests in predicting difficult intubation.Settings and Design:In this study, 200 patients belonging to age group 18–60 years of American Society of Anesthesiologists I and II, scheduled for surgery under general anesthesia requiring endotracheal intubation were enrolled. Patients with upper airway pathology, neck mass, and cervical spine injury were excluded from the study.Materials and Methods:An attending anesthesiologist conducted preoperative assessment and recorded parameters such as body mass index, modified Mallampati grading, inter-incisor distance, neck circumference, and thyromental distance (NC/TMD). After standard anesthetic induction, laryngoscopy was performed, and intubation difficulty assessed using intubation difficulty scale on the basis of seven variables.Statistical Analysis:The Chi-square test or student t-test was performed when appropriate. The binary multivariate logistic regression (forward-Wald) model was used to determine the independent risk factors.Results:Among the 200 patients, 26 patients had difficult intubation with an incidence of 13%. Among different variables, the Mallampati score and NC/TMD were independently associated with difficult intubation. Receiver operating characteristic curve showed a cut-off point of 3 or 4 for Mallampati score and 5.62 for NC/TMD to predict difficult intubation.Conclusion:The diagnostic accuracy of NC/TM ratio and Mallampatti score were better compared to other bedside tests to predict difficult intubation in Indian population.

Clinical Relevance of Mallampati Grading in Predicting Difficult Intubation in the Era of Various New Clinical Predictors

“…The disparity in the present study and study done by others can be explained by the exclusion criteria of the present study which did not include the patients with BMI>35 kg/mt2. The Neck Circumference is not a perfect indicator alone because the amount of soft tissue at the various region of neck is different [ 23 ]. But when multivariate binary logistic regression analysis was used, we found that neck circumference was statistically significant to differentiate between easy and difficult laryngoscopy with p= 0.004.…”

Ethnicity and upper airway measurements: A study in South Indian population

“…[ 13 ] Our incidence was similar to other studies in Indian population. [ 14 15 ] Looking at our demographic data we had more females. This could be since our hospital receives more female patients compared to the males in a ratio of 3:2 and all head and neck cancers which are more common in males fell in the exclusion criteria.…”

A prospective observational study of predictors of difficult intubation in Indian patients

“…[ 5 ] The mean interincisor gap in easy group was 4.2 ± 0.9 cm and in difficult group it was 3.5 ± 1.3 cm with P value of 0.005, this was compared with the other studies. [ 5 8 ] Wilson et al [ 5 ] and El-Ganzouri et al [ 9 ] reported that receding mandible as a good predictor of difficult intubation with P value of 0.0004 and 0.001, respectively. Subluxation <0 was the significant factor for prediction of difficult intubation with P value of 0.001.…”