Predicting Difficult Laryngoscopy in Acromegaly: A Comparison of Upper Lip Bite Test With Modified Mallampati Classification

Abstract

Upper lip bite test (ULBT) is a simple test for predicting difficult intubation. However, it has not been evaluated in acromegalic patients. The primary aim of this study was to compare ULBT with modified Mallampati classification (MMPC) to predict difficult laryngoscopy in acromegalic patients. Over a 5-year period, 64 acromegalic and 63 nonacromegalic patients presenting for excision of pituitary tumor were enrolled. Preoperative airway assessment was done using MMPC and the ULBT. Under anesthesia, laryngoscopic view was assessed using Cormack-Lehane (CL) grading. MMPC III/IV and ULBT grade III were considered predictive of difficult laryngoscopy that was defined as Cormack-Lehane grades III or IV. Difficult intubation was defined as more than 2 direct laryngoscopy attempts involving change of blade or use of bougie/fiberoptic bronchoscope/intubating laryngeal mask airway. Sensitivity, specificity, positive and negative predictive values, and accuracy of both tests in predicting difficult laryngoscopy were calculated. Incidence of difficult laryngoscopy and intubation in acromegalics were 24% and 11%, respectively. MMPC and ULBT predicted difficulty in 61% and 14% acromegalics, respectively. However, only 26% and 44% of the laryngoscopies predicted to be difficult by MMMC and ULBT, respectively, were actually difficult. MMPC failed to predict 33% of difficult laryngoscopies whereas ULBT failed to predict 73%. Neither test predicted difficulty in 33% laryngoscopies that turned out to be difficult. Twenty-seven percent of the difficult laryngoscopies were correctly predicted by both tests. In acromegalic group, MMPC was more sensitive, whereas ULBT was more specific. Sensitivity and accuracy of both tests were less in acromegalic patients compared with nonacromegalic controls.

Radiologic indicators for prediction of difficult laryngoscopy in patients with cervical spondylosis

“…Estimating a 24% incidence of difficult laryngoscopy,3 a sample size of 278 patients was calculated to have a power of 0.9 and a significance level of 0.05 to detect a difference in predictors between the difficult and easy laryngoscopy groups with PASS software (version 8.03; NCSS LLC, Kaysville, UT, USA). In consideration of potential dropouts, 315 patients were recruited for the study.…”

“…The incidence of difficult laryngoscopy and intubation ranges widely from 1.8% to 24.0% among different studies 1, 2, 3. Patients with cervical spondylosis have a higher incidence of difficult laryngoscopy than do patients without cervical spondylosis.…”

High levels of IGF-1 predict difficult intubation of patients with acromegaly

“…If the TTI exceeded 1 min, the intubation would be stopped, and the preoxygenation was performed to prepare for a second attempt at tracheal intubation. DI was defined as either an MMC of III or IV or a successful tracheal intubation after two or more attempts [10, 11]. The TTI was calculated from the time of the Macintosh laryngoscope blade placement into the patient’s mouth to proper inflation of the endotracheal tube cuff.…”

Reply to “Comparing Shikani Optical Stylet and Macintosh Laryngoscope for Orotracheal Intubation”

“…The definition of difficult airway in our paper should be difficult laryngoscopy, not difficult airway. [1] The laryngeal classification (Macintosh 3–4 blade) used in our study was defined according to the method of Cormack and Lehane,[23] in which the initial view should be performed without the application of external laryngeal pressure. We admitted that external laryngeal pressure might be used in clinical practice during laryngoscopy with Macintosh laryngoscope.…”