Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults

Patel, Bhavdip; Khandekar, Rajiv; Diwan, Rashesh; Shah, Ashok

doi:10.4103/0019-5049.130821

Cited by 31 publications

(20 citation statements)

References 16 publications

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“…Because difficult or failed endotracheal intubations are one of the leading causes of anesthesia-related morbidity and mortality in anesthetized patients, there is a need for accurate tests to predict difficult intubation [6, 7]. The ability to identify patients at risk of difficult tracheal intubation is important especially in patients with apparently normal airways.…”

Section: Introductionmentioning

confidence: 99%

Predictive Values of Preoperative Tests for Difficult Laryngoscopy and Intubation in Adult Patients at Tikur Anbessa Specialized Hospital

Tamire

Demelash

Admasu

2019

Anesthesiology Research and Practice

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Introduction. The significance of difficult or failed tracheal intubation following induction is a well-recognized cause of morbidity and mortality in anesthetic practice. Nevertheless, the need to predict potentially difficult tracheal intubation has received a little attention. During routine anesthesia, the incidence of difficult tracheal intubation has been estimated at 1.5%–8% of general anesthetics. Difficulties in intubation have been associated with serious complications, such as brain damage or death, particularly when failed intubation has occurred. Occasionally, in a patient with a difficult airway, the anesthetist is faced with the situation where mask ventilation proves difficult or impossible. This is one of the most critical emergencies that may be faced in the practice of anesthesia. If the anesthetist can predict which patients are likely to prove difficult to intubate, he/she may reduce the risks of anesthesia considerably. In Ethiopia, there are no data on the magnitude of difficult laryngoscopic tracheal intubation and no standard guidelines for preoperative tests. The main concern of this study was to provide information on the magnitude of difficult laryngoscopic intubation and to determine valuable preoperative tests to predict difficult laryngoscopy and intubation in patients with apparently normal airways which can help anesthetists to improve preoperative airway assessment and contribute to decrease anesthesia-related morbidity and mortality. Objective. The main objective of this study was to assess the magnitude and predictive values of preoperative tests for difficult laryngoscopy and intubation, among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation in Tikur Anbessa Hospital from February 1 to March 30, 2016. Study Design. A facility-based cross-sectional study design was used. Result. In this study, we found the magnitude of difficult laryngoscopy and intubation as 13.6% and 5%, respectively. 33.3% of patients with difficult laryngoscopy were found to be difficult for intubation. Mallampati test, interincisor distance, and thyromental distance were identified to be good preoperative tests to predict difficult laryngoscopic intubation when used in combination. Recommendation. We recommend anesthesia professionals to use combination of MMC/TMD/IID for their routine preoperative airway assessment.

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Section: Introductionmentioning

confidence: 99%

Predictive Values of Preoperative Tests for Difficult Laryngoscopy and Intubation in Adult Patients at Tikur Anbessa Specialized Hospital

Tamire

Demelash

Admasu

2019

Anesthesiology Research and Practice

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“…The reported incidence of DI in Indian population is 3.3%–21% in various studies enrolling 60–600 patients. [ 6 7 8 9 10 11 ] In a study of 330 patients, the authors demonstrated that incidence of difficult laryngoscopy and intubation was 9.7% and 4.5%, respectively, in Indian patients with apparently normal airways. They also reported very high (48%) incidence of ‘minor’ difficulty in intubation.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 ] The literature is sparse on the incidence of DI in Indian patients undergoing surgery. [ 6 7 8 9 10 11 ]…”

Section: Introductionmentioning

confidence: 99%

Are cardiac surgical patients at increased risk of difficult intubation?

Borde¹,

Daunde²,

Zine³

et al. 2017

Indian J Anaesth

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Background and Aims:Safe airway management is the cornerstone of contemporary anaesthesia practice, and difficult intubation (DI) remains a major cause of anaesthetic morbidity and mortality. The surgical category, particularly cardiac surgery as a risk factor for DI has not been studied extensively. The aim of this study was to test the hypothesis whether cardiac surgical patients are at increased risk of DI.Methods:During the study, 627 patients (329 cardiac and 298 non-cardiac surgical) were enrolled. Pre-operative demographic and other variables associated with DI were assessed. Patients with Cormack Lehane grade III and IV or use of bougie in Cormack grade II were defined as DI. The incidence of anticipated and unanticipated DI was assessed. Factors associated with DI were described using univariate and multivariate logistic regression models.Results:The overall incidence of DI was 122/627 (19.46%). The incidence of DI was higher in cardiac surgery patients (24%) as compared to non-cardiac surgery patients (14.4% P = 0.002). On multivariate analysis, factors independently associated with DI were greater age, male sex, higher Mallampati grade, and anticipated DI, but not cardiac surgery. The incidence of unanticipated DI was 48.1% and 53.4% in cardiac and non-cardiac surgery patients, respectively.Conclusion:Although there was a higher incidence of DI in cardiac surgical patients, cardiac surgery is not an independent risk factor for DI. Rather, other factors play more important role. About half of the DI both in cardiac and non-cardiac surgeries were unanticipated.

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“…Mainly they can be mentioned: Wilson (S 75% and E 88%), El-Ganzouri (S 65% and E 94%), Arne (S 94% and E 96%), Karkouti (S 86% and E 96%), and Naguib original (S 81% and E 72%) [8]. Recall that Mallampati plus thyromental distance and sternum distance is the combination of physical tests with greater discriminative power, with a sensitivity of 100% and specificity of 92.7% [11].…”

Section: Predictors Of Difficult Airwaymentioning

confidence: 99%

Imaging Tests for Predicting the Presence of Difficult Airway in Head and Neck Cancer Patients Undergoing Otorhinolaryngological Surgery

Franchi¹,

Merino²,

Calle³

et al. 2019

Neuroimaging - Structure, Function and Mind

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Patients with head and neck cancers represent a challenge for the surgical team from many points of view, but, especially, the surgical moment where greater stress generated corresponds to the perioperative management of the airway, because in many occasions we can face unexpected situations, most of the time, incidental findings can hinder ventilation and endotracheal intubation. Gutierrez et al., in 2018, decided to study four tomography measures and their correlation in anesthesia records with airway management difficulties. Material and methods: A retrospective, observational study was carried out in 104 patients operated by head and neck cancers over a period of 36 months, only in those with access to tomographic records. Four tomographic measurements were considered and were statistically related to the extreme degrees of visualization of the glottis (Cormack III-IV) and the presence of the physical examination of Mallampati III-IV. Results: After performing a multivariate model in the group of extreme degrees of visualization of the glottis, the results were not statistically significant (p > 0.05; 95% CI: 0.030-2.31: EPI/ PPW, 0.018-1.37 TB/PPW). In the Mallampati III-IV group, in the multivariate model only the VC/PPW showed clinically significant results (p < 0.05; 95% CI: 0.104-8.53). Conclusions: Tomographic measurements and the physical examination predictors could represent a useful guide in the prediction of the difficult airway in these patients.

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Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults

Cited by 31 publications

References 16 publications

Predictive Values of Preoperative Tests for Difficult Laryngoscopy and Intubation in Adult Patients at Tikur Anbessa Specialized Hospital

Predictive Values of Preoperative Tests for Difficult Laryngoscopy and Intubation in Adult Patients at Tikur Anbessa Specialized Hospital

Are cardiac surgical patients at increased risk of difficult intubation?

Imaging Tests for Predicting the Presence of Difficult Airway in Head and Neck Cancer Patients Undergoing Otorhinolaryngological Surgery

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