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The diagnostic value of the upper lip bite test combined with sternomental distance, thyromental distance, and interincisor distance for prediction of easy laryngoscopy and intubation: a prospective study.
Anesth Analg. 2009 Sep; 109(3):822-4.A&A

Abstract

BACKGROUND

Accuracy of upper lip bite test (ULBT) has been compared with the Mallampati classification. In this study, we investigated whether the combination of the ULBT classification with sternomental distance (SMD), thyromental distance (TMD), and interincisor distance (IID) or a composite score can improve the ability to predict easy laryngoscopy and intubation compared with each test alone.

METHODS

In a prospective study, 380 patients who were scheduled for elective surgery were selected randomly and enrolled in the study. Before inducing anesthesia, the airways were assessed, and ULBT class, SMD, TMD, and IID determined. Laryngoscopic view according to the Cormack and Lehane grading system was determined after induction of anesthesia and Grades 3 and 4 defined as "difficult intubation." By using receiver operating characteristic analysis, the best cutoff points of the tests were calculated. Finally, sensitivity, specificity, positive and negative predictive values and accuracy of these tests and their combinations with the ULBT were calculated.

RESULTS

The prevalence of difficult intubation was 5% (n = 19). Class III ULBT, IID <4.5 cm, TMD <6.5 cm, and SMD <13 cm were defined as predictors of difficult intubation. There was no significant difference regarding difficult intubation based on gender (P < 0.05), whereas there were significant differences between the older tests and laryngeal view (P < 0.05, Mc-Nemar test). Specificity and accuracy of the ULBT were significantly higher than TMD, SMD, and IID individually (specificity was 91.69%, 82.27%, 70.64%, and 82.27%, respectively, and accuracy was 91.05%, 71.32%, 81.84%, and 76.58%, respectively). The combination of the ULBT with SMD provided the highest sensitivity.

CONCLUSION

We conclude that the specificity and accuracy of the ULBT is significantly higher than the other tests and is more accurate in airway assessment. However, the ULBT in conjunction with the other tests could more reliably predict easy laryngoscopy or intubation.

Authors+Show Affiliations

Department of Anesthesiology, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. khanzh51@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19690252

Citation

Khan, Zahid Hussain, et al. "The Diagnostic Value of the Upper Lip Bite Test Combined With Sternomental Distance, Thyromental Distance, and Interincisor Distance for Prediction of Easy Laryngoscopy and Intubation: a Prospective Study." Anesthesia and Analgesia, vol. 109, no. 3, 2009, pp. 822-4.
Khan ZH, Mohammadi M, Rasouli MR, et al. The diagnostic value of the upper lip bite test combined with sternomental distance, thyromental distance, and interincisor distance for prediction of easy laryngoscopy and intubation: a prospective study. Anesth Analg. 2009;109(3):822-4.
Khan, Z. H., Mohammadi, M., Rasouli, M. R., Farrokhnia, F., & Khan, R. H. (2009). The diagnostic value of the upper lip bite test combined with sternomental distance, thyromental distance, and interincisor distance for prediction of easy laryngoscopy and intubation: a prospective study. Anesthesia and Analgesia, 109(3), 822-4. https://doi.org/10.1213/ane.0b013e3181af7f0d
Khan ZH, et al. The Diagnostic Value of the Upper Lip Bite Test Combined With Sternomental Distance, Thyromental Distance, and Interincisor Distance for Prediction of Easy Laryngoscopy and Intubation: a Prospective Study. Anesth Analg. 2009;109(3):822-4. PubMed PMID: 19690252.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The diagnostic value of the upper lip bite test combined with sternomental distance, thyromental distance, and interincisor distance for prediction of easy laryngoscopy and intubation: a prospective study. AU - Khan,Zahid Hussain, AU - Mohammadi,Mostafa, AU - Rasouli,Mohammad R, AU - Farrokhnia,Fahimeh, AU - Khan,Razmeh Hussain, PY - 2009/8/20/entrez PY - 2009/8/20/pubmed PY - 2009/9/10/medline SP - 822 EP - 4 JF - Anesthesia and analgesia JO - Anesth Analg VL - 109 IS - 3 N2 - BACKGROUND: Accuracy of upper lip bite test (ULBT) has been compared with the Mallampati classification. In this study, we investigated whether the combination of the ULBT classification with sternomental distance (SMD), thyromental distance (TMD), and interincisor distance (IID) or a composite score can improve the ability to predict easy laryngoscopy and intubation compared with each test alone. METHODS: In a prospective study, 380 patients who were scheduled for elective surgery were selected randomly and enrolled in the study. Before inducing anesthesia, the airways were assessed, and ULBT class, SMD, TMD, and IID determined. Laryngoscopic view according to the Cormack and Lehane grading system was determined after induction of anesthesia and Grades 3 and 4 defined as "difficult intubation." By using receiver operating characteristic analysis, the best cutoff points of the tests were calculated. Finally, sensitivity, specificity, positive and negative predictive values and accuracy of these tests and their combinations with the ULBT were calculated. RESULTS: The prevalence of difficult intubation was 5% (n = 19). Class III ULBT, IID <4.5 cm, TMD <6.5 cm, and SMD <13 cm were defined as predictors of difficult intubation. There was no significant difference regarding difficult intubation based on gender (P < 0.05), whereas there were significant differences between the older tests and laryngeal view (P < 0.05, Mc-Nemar test). Specificity and accuracy of the ULBT were significantly higher than TMD, SMD, and IID individually (specificity was 91.69%, 82.27%, 70.64%, and 82.27%, respectively, and accuracy was 91.05%, 71.32%, 81.84%, and 76.58%, respectively). The combination of the ULBT with SMD provided the highest sensitivity. CONCLUSION: We conclude that the specificity and accuracy of the ULBT is significantly higher than the other tests and is more accurate in airway assessment. However, the ULBT in conjunction with the other tests could more reliably predict easy laryngoscopy or intubation. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19690252/The_diagnostic_value_of_the_upper_lip_bite_test_combined_with_sternomental_distance_thyromental_distance_and_interincisor_distance_for_prediction_of_easy_laryngoscopy_and_intubation:_a_prospective_study_ L2 - https://doi.org/10.1213/ane.0b013e3181af7f0d DB - PRIME DP - Unbound Medicine ER -