A Prospective Study to Predict difficult intubation using Simple Non-Invasive Tests
Journal Title: International Journal of Contemporary Medical Research - Year 2016, Vol 3, Issue 8
Abstract
Introduction: Failure to achieve endotracheal intubation causes considerable morbidity and mortality in anaesthetised patients. Preoperative identification of such patients would help the Anesthesiologist to be prepared for such a difficult situation. The purpose of our study was to determine the ability to predict difficult visualization of larynx using the Upper Lip Bite Test (ULBT), Hyomental distance (HMD), Thyrosternal distance (TSD), and the Mandibular length (ML). Material and methods: Study group included 100 patients undergoing elective surgical procedures under general anaesthesia with endotracheal intubation. ULBT, HMD, TSD and ML measurements were performed on all patients preoperatively. ULBT class III, HMD <3.5cm, TSD < 6.5cm and ML< 9cm were considered potentially difficult intubation. An experienced anesthesiologist, unaware of preoperative airway evaluation, performed the laryngoscopy and graded the glottic view(as per Cormack and Lehane's (CL) classification). CL Grade III and IV were considered as difficult intubation. We calculated the Sensitivity, specificity, accuracy, positive and negative predictive values of upper lip bite test and Modified Mallampati test. Results: ULBT had a sensitivity, specificity, PPV and NPV of 45.45%, 100%, 100% and 93.68%, respectively. HMD showed a Sensitivity, Specificity, PPV and NPV of 9.09%, 97.75%, 33.33% and 89.69%, respectively. TSD showed a Sensitivity and PPV came of 0% while the Specificity and NPV of the test to be 97.75% and 88.78%, respectively. ML showed Sensitivity, Specificity, PPV and NPV and found of 18.18%, 98.88%, 66.67% and 90.72%, respectively. Conclusion. ULBT comes out to be a better predictor of Difficult Intubation over HMD, TSD and ML. Though, ULBT appears to be better amongst the four tests, none of them is a foolproof test. None of them can be used as a reliable screening test as no one had a sensitivity even more than 50%. But, ULBT is better predictor amongst above parameters.
Authors and Affiliations
Amit Dalvi, Sarita Fernandes, Swapnil Aswar
Keywords
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