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Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section.
Balkan Med J. 2017 Sep 29; 34(5):436-443.BM

Abstract

BACKGROUND

Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients.

AIMS

To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients.

STUDY DESIGN

Cross-sectional study.

METHODS

Pregnant women (n=250) scheduled for caesarean section were analysed. The patients' ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification.

RESULTS

No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05). The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively. We found a sensitivity and specificity of 93.75 and 95.30, respectively, for the combination of the upper limb bite test with the thyromental distance test. The sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test and interincisor distance test were found to be 46.15 and 100, respectively. For combination of all the tests, the sensitivity and specificity was 42.31 and 100, respectively.

CONCLUSION

When all combinations are evaluated in the decision of difficult intubation, the combination of the upper limb bite test and thyromental distance test is superior to the use of other methods alone to predict difficult intubation in pregnant women.

Authors+Show Affiliations

Clinic of Anesthesiology, Uzunköprü Public Hospital, Edirne, Turkey.Department of Anesthesiology and Reanimation, Trakya University School of Medicine, Edirne, Turkey.Department of Anesthesiology and Reanimation, Trakya University School of Medicine, Edirne, Turkey.Department of Biostatistics, Trakya University School of Medicine, Edirne, Turkey.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28443579

Citation

Yıldırım, İlker, et al. "Determining the Efficiency of Different Preoperative Difficult Intubation Tests On Patients Undergoing Caesarean Section." Balkan Medical Journal, vol. 34, no. 5, 2017, pp. 436-443.
Yıldırım İ, İnal MT, Memiş D, et al. Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section. Balkan Med J. 2017;34(5):436-443.
Yıldırım, İ., İnal, M. T., Memiş, D., & Turan, F. N. (2017). Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section. Balkan Medical Journal, 34(5), 436-443. https://doi.org/10.4274/balkanmedj.2016.0877
Yıldırım İ, et al. Determining the Efficiency of Different Preoperative Difficult Intubation Tests On Patients Undergoing Caesarean Section. Balkan Med J. 2017 Sep 29;34(5):436-443. PubMed PMID: 28443579.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section. AU - Yıldırım,İlker, AU - İnal,Mehmet Turan, AU - Memiş,Dilek, AU - Turan,F Nesrin, Y1 - 2017/04/13/ PY - 2017/4/27/pubmed PY - 2018/6/12/medline PY - 2017/4/27/entrez KW - Caesarean section KW - difficult intubation predictive tests. SP - 436 EP - 443 JF - Balkan medical journal JO - Balkan Med J VL - 34 IS - 5 N2 - BACKGROUND: Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. AIMS: To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. STUDY DESIGN: Cross-sectional study. METHODS: Pregnant women (n=250) scheduled for caesarean section were analysed. The patients' ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. RESULTS: No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05). The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively. We found a sensitivity and specificity of 93.75 and 95.30, respectively, for the combination of the upper limb bite test with the thyromental distance test. The sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test and interincisor distance test were found to be 46.15 and 100, respectively. For combination of all the tests, the sensitivity and specificity was 42.31 and 100, respectively. CONCLUSION: When all combinations are evaluated in the decision of difficult intubation, the combination of the upper limb bite test and thyromental distance test is superior to the use of other methods alone to predict difficult intubation in pregnant women. SN - 2146-3131 UR - https://www.unboundmedicine.com/medline/citation/28443579/Determining_the_Efficiency_of_Different_Preoperative_Difficult_Intubation_Tests_on_Patients_Undergoing_Caesarean_Section_ L2 - https://doi.org/10.4274/balkanmedj.2016.0877 DB - PRIME DP - Unbound Medicine ER -