Modified Mallampati Test, Sternomental Distance, and Thyromental Distance for Prediction of Difficult Intubation in Patients Undergoing General Anaesthesia
Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 10
Abstract
Background and Objectives: Airway management is the fundamental responsibility of every anesthesialogist. Difficult intubation is one of the major causes of anesthesia-related morbidity and mortality. The risk and complications related to difficult intubation can be reduced if difficult airway is anticipated preoperatively. There are many simple bed side tests to predict difficult intubation preoperatively. There are several studies comparing the different preoperative bedside tests in predicting difficult intubation with varying results. However, limited information is available on effect of combining these parameters in enhancing the preoperative prediction of a difficult airway Aim: To assess the validity and efficacy of modified Mallampati test (MMT), sternomental distance (SMD), Thyromental distance (TMD) individually and in combination in predicting difficult intubation. Methodology: This is an observational study, conducted in the department of Anaesthesiology Government Medical College Thiruvananthapuram, a tertiary care centre . 305 Patients aged between 18 to 65 years, undergoing elective major surgeries in Govt: Medical College Hospital, Thiruvananthapuram, Kerala, were selected as the study population. The airway was assessed by Modified Mallampati test (MMT), class III & IV were considered as difficult intubation. Thyromental distance (TMD) of every patient was recorded. A measurement of less than 6.5 cm was considered to be a predictor of difficult intubation. Sternomental distance (SMD) was measured and a measurement of less than 12.5cms was considered to be a predictor of difficult intubation. A senior anesthesiologist with more than three years of experience assessed the laryngeal view by direct laryngoscopy using Cormack &Lehane grading during intubation. Grade 3 and 4 was considered difficult laryngoscopy and intubation. The validity parameters such as sensitivity, specificity, false positive and negative values, positive predictive value (PPV) and negative predictive value (NPV) were calculated. The effect of combining different measurements on the validity was also studie Results MMT: Sensitivity 40.7%, Specificity 92.4%, PPV 34.4%, NPV 94.1%, Accuracy 87.9% SMD: Sensitivity 81.5%, Specificity 93.9%, PPV 56.4%, NPV 98.1%, Accuracy 92.8% TMD: Sensitivity 88.9%, Specificity 80.9%, PPV 31.2%, NPV 98.7%, Accuracy 81.6% MMT + SMD: Sensitivity 100.0%, Specificity 86.7%, PPV 42.2%, NPV 100.0%, Accuracy 87.9% MMT + TMD: Sensitivity 96.3%, Specificity 75.2%, PPV 27.4%, NPV 99.5%, Accuracy 77.0% SMD + TMD: Sensitivity 92.6%, Specificity 78.4%, PPV 29.4%, NPV 99.1%, Accuracy 79.7% MMT + SMD + TMD: Sensitivity 100.0%, Specificity 72.7%, PPV 26.2%, NPV 100.0%, Accuracy 75.1% Conclusion: TMD had high sensitivity. MMT and SMD had high specificity. The validity and efficacy of combination of MMT and SMD as compared to any single test alone was very high in predicting difficult intubation. Efficacy of combining MMT, SMD and TMD is also significantly higher than any single test. Hence all the three tests should be ideally used in assessing the airway in adult patients for surgery under GA.
Authors and Affiliations
Dr Madhusoodanan Pillai
Keywords
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