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Prediction of ease of laryngoscopy and intubation-role of upper lip bite test, modified mallampati classification, and thyromental distance in various combination.
J Family Med Prim Care. 2015 Jan-Mar; 4(1):101-5.JF

Abstract

BACKGROUND

The incidence of difficult intubation in patients undergoing general anaesthesia is estimated to be approximately 1-18% whereas that of failure to intubate is 0.05-0.35%.1,2,3 Various methods have been used for prediction of difficult laryngoscopy. Although, upper lip bite has been shown to be a promising test in its introductory article, repeated validation in various populations is required for any test to be accepted as a routine test. We have compared upper lip bite test (ULBT), modified Mallampati test (MMC) and thyromental distance (TMD) individually and in various combinations to verify which of these predictor tests are significantly associated with difficult glottic exposure.

METHODS

After obtaining institutional ethics committee approval, 402 ASA I and II adult patients undergoing elective surgical procedures requiring endotracheal intubation were included. All the three test were performed in all the patients preoperatively and their glottic exposure was recorded by Cormack-Lehane classification during intubation. Sensitivity, specificity, positive predictive value and negative predictive value were used for comparison.

RESULTS

In our study, the incidence of difficult laryngoscopy was 11.4% and failure to intubate 0.49%. None of the three are a suitable predictive test when used alone. Combination of tests added incremental diagnostic value.

CONCLUSION

We conclude that all three screening tests for difficult intubation have only poor to moderate discriminative power when used alone. Combinations of individual tests add some incremental diagnostic value.

Authors+Show Affiliations

Bhabha Atomic Centre, King Edward Memorial Hospital, Mumbai, India.Department of Anaesthesia, Bhabha Atomic Research Centre Hospital, Mumbai, Maharashtra, India.Department of Anaesthesia, Bhabha Atomic Research Centre Hospital, Mumbai, Maharashtra, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25810998

Citation

Wajekar, Anjana S., et al. "Prediction of Ease of Laryngoscopy and Intubation-role of Upper Lip Bite Test, Modified Mallampati Classification, and Thyromental Distance in Various Combination." Journal of Family Medicine and Primary Care, vol. 4, no. 1, 2015, pp. 101-5.
Wajekar AS, Chellam S, Toal PV. Prediction of ease of laryngoscopy and intubation-role of upper lip bite test, modified mallampati classification, and thyromental distance in various combination. J Family Med Prim Care. 2015;4(1):101-5.
Wajekar, A. S., Chellam, S., & Toal, P. V. (2015). Prediction of ease of laryngoscopy and intubation-role of upper lip bite test, modified mallampati classification, and thyromental distance in various combination. Journal of Family Medicine and Primary Care, 4(1), 101-5. https://doi.org/10.4103/2249-4863.152264
Wajekar AS, Chellam S, Toal PV. Prediction of Ease of Laryngoscopy and Intubation-role of Upper Lip Bite Test, Modified Mallampati Classification, and Thyromental Distance in Various Combination. J Family Med Prim Care. 2015 Jan-Mar;4(1):101-5. PubMed PMID: 25810998.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of ease of laryngoscopy and intubation-role of upper lip bite test, modified mallampati classification, and thyromental distance in various combination. AU - Wajekar,Anjana S, AU - Chellam,Shrividya, AU - Toal,Pratibha V, PY - 2015/3/27/entrez PY - 2015/3/27/pubmed PY - 2015/3/27/medline KW - Difficult airway KW - Mallampati classification KW - thyromental distance KW - upper lip bite test SP - 101 EP - 5 JF - Journal of family medicine and primary care JO - J Family Med Prim Care VL - 4 IS - 1 N2 - BACKGROUND: The incidence of difficult intubation in patients undergoing general anaesthesia is estimated to be approximately 1-18% whereas that of failure to intubate is 0.05-0.35%.1,2,3 Various methods have been used for prediction of difficult laryngoscopy. Although, upper lip bite has been shown to be a promising test in its introductory article, repeated validation in various populations is required for any test to be accepted as a routine test. We have compared upper lip bite test (ULBT), modified Mallampati test (MMC) and thyromental distance (TMD) individually and in various combinations to verify which of these predictor tests are significantly associated with difficult glottic exposure. METHODS: After obtaining institutional ethics committee approval, 402 ASA I and II adult patients undergoing elective surgical procedures requiring endotracheal intubation were included. All the three test were performed in all the patients preoperatively and their glottic exposure was recorded by Cormack-Lehane classification during intubation. Sensitivity, specificity, positive predictive value and negative predictive value were used for comparison. RESULTS: In our study, the incidence of difficult laryngoscopy was 11.4% and failure to intubate 0.49%. None of the three are a suitable predictive test when used alone. Combination of tests added incremental diagnostic value. CONCLUSION: We conclude that all three screening tests for difficult intubation have only poor to moderate discriminative power when used alone. Combinations of individual tests add some incremental diagnostic value. SN - 2249-4863 UR - https://www.unboundmedicine.com/medline/citation/25810998/Prediction_of_ease_of_laryngoscopy_and_intubation_role_of_upper_lip_bite_test_modified_mallampati_classification_and_thyromental_distance_in_various_combination_ L2 - http://www.jfmpc.com/article.asp?issn=2249-4863;year=2015;volume=4;issue=1;spage=101;epage=105;aulast=Wajekar DB - PRIME DP - Unbound Medicine ER -
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