scholarly journals Comparison of Upper Lip Bite Test with Modified Mallampati Score in Predicting Difficult Intubation

2022 ◽  
Vol 7 (1) ◽  
pp. 1-8
Author(s):  
Monish Thomas ◽  
Nichelle M. Saldanha
Keyword(s):  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Anaesthetic Management ◽  
Class Iii ◽  
Upper Lip ◽  
Intubation Difficulty ◽  
Mallampati Score ◽  
Difficulty Scale ◽  
A Prospective Study

Background and Aims: Identifying a patient with a difficult airway is important in planning anaesthetic management so that endotracheal intubation can be achieved safely. This study aims to compare modified Mallampati score with Upper Lip Bite Test to predict difficult intubation using intubation difficulty scale. Materials and methods: A prospective study was carried on 104 patients, both sexes aged between 18 to 60 years scheduled for elective surgeries under general anaesthesia fulfilling inclusion and exclusion criteria. Patient airway was evaluated by MMT and ULBT preoperatively. Predictors of difficult endotracheal intubation were assigned to MMT class III and IV, ULBT class III. After premedication and induction laryngoscopy was performed. After successful intubation Intubation difficulty score was noted down based on the sum of seven assessing parameters. A score >5 was considered difficult intubation. Results: The incidence of difficult intubation in the study was 10.6% (i.e. 11 out of 104 patients). In this study ULBT had a higher sensitivity (90.9% v/s 18.20%), specificity (95.7% v/s 75.3%) PPV (71.4% v/s 8%) and NPV (98.9% v/s 88.6%) than that of MMT Conclusion: Upper lip bite test is better at predicting difficult intubation with higher accuracy when compared to Modified Mallampati test. Both the tests are good predictors of easy intubation. Keywords: Upper Lip Bite Test (ULBT), Modified Mallampati test (MMT), Intubation Difficulty scale (IDS), airway assessment. Difficult intubation prediction, Difficult airway

PREDICTION OF DIFFICULT INTUBATION BY USING UPPER LIP BITE, THYROMENTAL DISTANCE AND MALLAMPATI SCORE IN COMPARISON TO CORMACK AND LEHANE CLASSIFICATION SYSTEM

2021 ◽  
Vol 74 (9) ◽  
pp. 2305-2314
Author(s):  
Ahmed Salam Dawood ◽  
Bashar Zuhair Talib ◽  
Istabraq Sadoon Sabri
Keyword(s):  
Endotracheal Intubation ◽  
Sensitivity And Specificity ◽  
Difficult Intubation ◽  
Classification System ◽  
Elective Surgery ◽  
Upper Lip ◽  
Cross Sectional ◽  
Mallampati Score ◽  
Routine Monitoring ◽  
Venous Cannula

The aim: To evaluate efficacy of Modified Mallampati test (MMT), upper lip bite test (ULBT) and Thyromental distance (TMD) or combination of two method Modified Mallampati test (MMT)+ upper lip bite test (ULBT), Thyromental distance (TMD) + upper lip bite test (ULBT) in prediction of difficult intubation in patients undergoing GA. Materials and methods: Three tests were carried out in all patients by a single anesthesiologist. These were MMT, ULBT and TMD. Laryngoscopy was performed with patient’s head in the sniffing position. The laryngoscopy view was graded according to modified Cormack and Lehane classification system. Study was prospective, single cross sectional, in 151 adult patients who required GA with endotracheal intubation for elective surgery. On arrival in the operating room, routine monitoring and venous cannula were introduced. Midazolam, Fentanyl. and rocuronium, ketamine , propofol were given to facilitate endotracheal intubation. Results: Out of 150 assessed patients, 18 (12%) had difficult intubation. Of those 18 patients, 17 (83.33%) patients had Cormack and Lehane classification III and one patient (16.67%) had classification IV. Compared with Cormack and Lehane classification system as the gold standard for difficult intubation, the sensitivity and specificity of MMT was 66.67% and 96.97% respectively, while ULBT had a sensitivity of 77.78% and a specificity of 93.18%, and TMD had a sensitivity of 55.56% and specificity of 94.97% respectively. A combination of different tests improved their efficiencies. The sensitivity and specificity MMT and TMD combinations was 77.78% and 92.42% respectively, while it was 88.89% and 93.18%, respectively for MMT and ULPT. The combination of TMD and ULBT has a sensitivity of 88.33% and a specificity of 91.67%. Conclusions: Upper lip biting test has the best sensitivity while MMT had the best specificity. No single test alone can be reliable for predicting of difficult intubation. The combination of ULBT and MMT was the best in terms of both sensitivity and specificity for prediction of difficult intubation.

scholarly journals Relationship of neck circumference and difficult endotracheal intubation in obese patients

2017 ◽  
Vol 4 (2) ◽  
pp. 3-9
Author(s):  
Amit Kumar Karna ◽  
Khalid Bashir
Keyword(s):  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Pearson Correlation ◽  
Anesthetic Management ◽  
Cricoid Cartilage ◽  
Neck Circumference ◽  
Obese Patients ◽  
Patient Identification ◽  
Intubation Difficulty ◽  
Difficulty Scale

Background and Objectives: Patient identification with difficult intubation is important in planning anesthetic management and one major factor for difficult intubation in t he obese patients is large neck circumference. The need for prediction of a potentially difficult airway received great importance as it plays a significant role in reducing morbidity and mortality. Therefore, this study was done to glimpse the effect of neck circumference on endotracheal intubation and to determine the frequency of difficult intubation.Material and Methods: The study was cross sectional descriptive study and convenient sampling technique was used. Seventy patients of age between 19-50 years of both sexes were enrolled. Neck circumference was measured at the level of cricoid cartilage along with other airway assessments. Direct laryngoscopy was done and checked whether it is difficult one or easy using Intubation difficulty scale. Data were entered and analyzed by using statistical software SPSS version 15.0. Results: Mean BMI was noted as 33.02±2.30 kg/m2 and the mean neck circumference was 43.64±2.30 cm. Difficult intubation was observed in 23 (32.86%) patients with mean neck circumference of 45.44±1.88 cm and normal intubation observed in 47(67.14%) patients with mean neck circumference of 42.77±1.98 cm. Linear correlation was found between the neck circumference and Intubation Difficulty Scale score with value of Pearson correlation=0.617 .Conclusion: Neck circumference of patient was found to have significant effects on difficult intubation. Frequency of difficult intubation was found in almost one third of obese patients with increasing neck circumference.Janaki Medical College Journal of Medical Sciences (2016) Vol. 4 (2): 3-9 

scholarly journals Application of high-flow nasal oxygenation as a rescue therapy in difficult videolaryngoscopic intubation

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110100
Author(s):  
Min Ho Lee ◽  
Hyun Joo Kim
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Rescue Therapy ◽  
High Flow ◽  
Mask Ventilation ◽  
Induction Process ◽  
Management Method ◽  
Adequate Oxygenation

In difficult airway situations, the next step of the airway management method is selected according to the prior presence of difficulties in mask ventilation and endotracheal intubation. It is important for the practitioner to be calm, quick in judgment, and take action in cases of difficult intubation. Recently, high-flow nasal oxygenation has been rapidly introduced into the anesthesiology field. This technique could extend the safe apnea time to desaturation. Especially, it maintains adequate oxygenation even in apnea and allows time for intubation or alternative airway management. We report two cases in which high-flow nasal oxygenation was implemented in the middle of the induction process after quick judgment by clinicians. High-flow nasal oxygenation was successfully used to assist in prolonging the safe apnea time during delicate airway securing attempts.

scholarly journals Difficult Airway Prediction Score for Intubation in Emergency Departments: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Sorravit Savatmongkorngul ◽  
Panrikan Pitakwong ◽  
Pungkava Srichar ◽  
Chaiyaporn Yuksen ◽  
Chetsadakon Jenpanitpong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Prediction Score ◽  
Care Hospital ◽  
Inclusion Criteria ◽  
Assessment Score ◽  
Airway Assessment ◽  
Lehane Grade

Abstract Objective: Difficult intubation is associated with an increasing number of endotracheal intubation attempts. Repeated endotracheal intubation attempts are in turn associated with an increased risk of adverse events. Clinical prediction tools to predict difficult airway have limited application in emergency airway situations. This study was performed to develop a new model for predicting difficult intubation in the emergency department.Methods: This retrospective study was conducted using an exploratory model at the Emergency Medicine of Ramathibodi Hospital, a university-affiliated super-tertiary care hospital in Bangkok, Thailand. The study was conducted from June 2018 to July 2020. The inclusion criteria were an age of ≥15 years and treatment by emergency intubation in the emergency department. Difficult intubation was defined as a Cormack–Lehane grade III or IV laryngoscopic view. The predictive model and prediction score for detecting difficult intubation were developed by multivariable regression analysis.Results: During the study period, 617 patients met the inclusion criteria; of these, 83 (13.45%) had difficult intubation. Five independent factors were predictive of difficult intubation. The difficult airway assessment score that we developed to predict difficult airway intubation had an accuracy of 89%. A score of >4 increased the likelihood ratio of difficult intubation by 7.62 times.Conclusion: A difficult airway assessment score of >4 was associated with difficult intubation.

scholarly journals Comparison of Laryngoscopic Views between C-MAC™ and Conventional Laryngoscopy in Patients with Multiple Preoperative Prognostic Criteria of Difficult Intubation. An Observational Cross-Sectional Study

Medicina ◽  
2019 ◽  
Vol 55 (12) ◽  
pp. 760
Author(s):  
Aikaterini Amaniti ◽  
Panagiota Papakonstantinou ◽  
Dimitrios Gkinas ◽  
Ioannis Dalakakis ◽  
Evangelia Papapostolou ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Difficult Intubation ◽  
Elective Surgery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cross Sectional Study ◽  
Laryngoscopic View ◽  
Cross Sectional ◽  
Intubation Difficulty ◽  
Difficulty Scale

Background and Objectives: Video laryngoscopy has been proven useful under difficult airway scenarios, but it is unclear whether anticipated improvement of visualization is related to specific difficult intubation prognostic factors. The present study evaluated the change in laryngoscopic view between conventional and C-MAC® laryngoscopy and the presence of multiple difficult intubation risk factors. Materials and Methods: Patients scheduled for elective surgery with >2 difficult intubation factors, (Mallampati, thyromental distance (TMD), interinscisor gap, buck teeth, upper lip bite test, cervical motility, body mass index (BMI)) were eligible. Patients underwent direct laryngoscopy (DL) followed by C-MAC™ laryngoscopy (VL) and intubation. Change of view between DL and VL, time for best view, intubation difficulty scale (IDS) and correlation between prognostic factors, laryngoscopic view improvement, and IDS were measured. Results: One-hundred and seventy-six patients completed the study. VL lead to fewer Cormarck–Lehane (C/L) III-IV, compared to DL (13.6% versus 54.6%, p < 0.001). The time to best view was also shorter (VL: 10.82 s, DL: 12.08 s, p = 0.19). Mallampati III-IV and TMD ≤ 6 cm were related to improvement of C/L between DL and VL. Logistic regression showed these two factors to be a significant risk factor of the glottis view change (p = 0.006, AUC-ROC = 0.57, 95% CI: 0.47–0.66). 175/176 patients were intubated with VL. 108/176 were graded as 0 < IDS ≤ 5 and 12/176 as IDS > 5. IDS was only correlated to the VL view (p < 0.0001). Conclusion: VL improved laryngoscopic view in patients with multiple factors of difficult intubation. Mallampati and TMD were related to the improved view. However, intubation difficulty was only related to the VL view and not to prognostic factors.

scholarly journals A predictive formula for difficult endotracheal intubation in the emergency department

2020 ◽  
Author(s):  
En-Chih Liao ◽  
Wen-Han Chang ◽  
Ching-Hsiang Yu ◽  
Cheng-Ying Shen ◽  
Fang-Ju Sun ◽  
...  
Keyword(s):  
Emergency Department ◽  
Airway Obstruction ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Upper Airway ◽  
High Body Mass Index ◽  
Upper Airway Obstruction ◽  
Binary Logistic Regression Model ◽  
Difficult Endotracheal Intubation

Abstract Background Current predictors for evaluating difficult endotracheal intubation had poor accessibility or sensitivity at the emergency department, so we evaluated the incidence and predictive factors, then built an easy-to-use predictive formula. Methods This was a 17-month prospective observational study. For the 110 patients, difficult airway was defined as Cormack & Lehane classification grade III and IV at first attempt of intubation. The univariate associations between patient characteristics and difficult endotracheal intubation were then analyzed, and the significantly associated factors were included in a multivariate binary logistic regression model then a predictive formula was generated. Generalized association plot (GAP) was used to show the relationship between each variable. Results The incidence of difficult intubation in our study was 35.5%. In the difficult airway group, significantly higher rates (p < 0.05) of high body mass index (BMI); double chin; thick, short neck; Mallampati difficulty; smaller inter-incisors distance; smaller thyromental distance; and upper airway obstruction were noted. Finally, a predictive formula for difficult intubation was successfully established by the combination of four predictors: BMI (odds ratio [OR] = 1.270), thyromental distance (OR = 0.614), upper airway obstruction (OR = 4.038), and Mallampati difficulty (OR = 5.163). A cut-off score of 4 provided the best sensitivity (79.5%) and specificity (81.7%)(95% CI: 0.794 to 0.938). Conclusions Our predictive formula could be used by emergency physicians to quickly identify and carefully manage patients with potentially difficult intubation. Early expert consultation could be sought when necessary.

Comparison of four methods for predicting difficult intubation

2016 ◽  
Vol 5 (01) ◽  
pp. 4720
Author(s):  
Javaher Foroosh Zadeh F ◽  
Safaii Sara
Keyword(s):  
Difficult Intubation ◽  
Elective Surgery ◽  
Upper Lip ◽  
Laryngoscopic View ◽  
Predictive Values ◽  
Significant Difference ◽  
Combined Test ◽  
Predicted Values ◽  
Sensitivity Specificity ◽  
A Prospective Study

Confirmation of endotracheal tube appointment is of critical importance, since unrecognized esophageal intubation can be rapidly lethal (death, brain damage). The aim of our study was to compare four different methods for prediction of difficult intubation: Mallampati, Thyro-mental distance, ULBT (Upper Lip Bite Test), and Inter incisicor gap. In a prospective study, 448 patients with a mean age of 53.5 who were scheduled for elective surgery were selected randomly and enrolled. Before induction of anesthesia, the airways were assessed by Mallampati test, Thyro mental distance, Upper lip bit test(ULBT) and Inter incisor gap. 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.” Degree of observed difficulty of intubation was compared to predicted values. Sensitivity, specificity, positive and negative predictive values and accuracy of these tests and their combinations with the ULBT were calculated. Statistical analysis was performed using SPSS version 16. Data were analysis by using Fishers exact and McNemar's test, and a Pvalue. <0.05 was considered statistically significant.  The prevalence of difficult intubation Cormack-Lehane in this study was 8.4%, Mallampati test had the highest sensitivity (47.3%) and Thyro-mental distance was most specific (96%). The ULBT (upper lip bite tests) had most positive and negative predictive value (37.9% & 93. 5%).Data also showed that power of these tests in predicting easy intubation is more than their ability in assessing the likelihood 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). Despite the validity of MMP, TMD, ULBT and IIG in predicting easy intubation is much greater than the value in prediction of difficult intubation; however, the simplicity of performing these tests and results of the four tests in evaluating patients before surgery by combination of tests in predicting difficult intubation will likely safe. It seems that best results are from applying combined test than a single one.

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