Predicting Difficult Laryngoscopy and Intubation With Laryngoscopic Exam Test: A New Method
AbstractAirway assessment is fundamental skill for anesthesiologists and failure to maintain a patient’s airway is the tremendous cause of anesthesia-related morbidity and mortality. None of the tests which have recommended for predicting difficult intubation stands out to be the best clinical test or have high diagnostic accuracy. Our study aimed to determine the utility of a new test as “laryngoscopic exam test (LET)” in predicting difficult intubation. Three hundred and eleven patients aged 16-60 years participated and completed the study. Airway assessment was carried out with modified Mallampati test, upper lip bit test and LET preoperatively, and Cormack and Lehane's grading of laryngoscopy were assessed during intubation as a gold standard, and difficult laryngoscopy was considered as Cormack and Lehane's grade ΙΙΙ or ΙV of laryngoscopic view. The incidence of difficult intubation was 6.1%. The LET showed higher sensitivity, specificity, and accuracy (P<0.05), without revealing significant differences among three tests (P=0.375). The LET is a simple bedside test and an alternative method for predicting difficult intubation.
Rucker JC, Cole D, Guerina LR, Zoran N, Chung F, Friedman Z. A prospective observational evaluation of an anatomically guided, logically formulated airway measure to predict difficult laryngoscopy. European Journal of Anaesthesiology (EJA). 2012;29(5):213-7.
Adamus M, Fritscherova S, Hrabalek L, Gabrhelik T, Zapletalova J, Janout V. Mallampati test as a predictor of laryngoscopic view. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010;154(4):339-43.
Kim W, Ahn H, Lee C, Shin B, Ko J, Choi S, et al. Neck circumference to thyromental distance ratio: a new predictor of difficult intubation in obese patients. British journal of anaesthesia. 2011:aer024.
Cheney FW, Posner KL, Lee LA, Caplan RA, Domino KB. Trends in anesthesia-related death and brain damage. Anesthesiology. 2006;105(6):1081-6.
Shiga T, Wajima Zi, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005;103(2):429-37.
Budde AO, Desciak M, Reddy V, Falcucci OA, Vaida SJ, Pott LM. The prediction of difficult intubation in obese patients using mirror indirect laryngoscopy: A prospective pilot study. Journal of anaesthesiology, clinical pharmacology. 2013;29(2):183.
Khan ZH, Eskandari S, Yekaninejad MS. A comparison of the Mallampati test in supine and upright positions with and without phonation in predicting difficult laryngoscopy and intubation: A prospective study. Journal of anaesthesiology, clinical pharmacology. 2015;31(2):207.
Khan ZH, Kashfi A, Ebrahimkhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesthesia & Analgesia. 2003;96(2):595-9.
Langeron O, Cuvillon P, Ibanez-Esteve C, Lenfant F, Riou B, Yannick Le Manach M. Prediction of Difficult Tracheal Intubation Time for. Anesthesiology. 2012;117(6):1223.
Adamus M, Jor O, Vavreckova T, Hrabalek L, Zapletalova J, Gabrhelik T, et al. Inter-observer reproducibility of 15 tests used for predicting difficult intubation. Biomedical Papers. 2011;155(3):275-81.
Ambesh SP, Singh N, Rao PB, Gupta D, Singh PK, Singh U. A combination of the modified Mallampati score, thyromental distance, anatomical abnormality, and cervical mobility (M-TAC) predicts difficult laryngoscopy better than Mallampati classification. Acta Anaesthesiologica Taiwanica. 2013;51(2):58-62.
Haq MIU, Ullah H. Comparison of Mallampati test with lower jaw protrusion maneuver in predicting difficult laryngoscopy and intubation. Journal of anaesthesiology, clinical pharmacology. 2013;29(3):313.
Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251.
Massey BT. Physiology of oral cavity, pharynx and upper esophageal sphincter. GI Motility online. 2006.
Davies AE, Kidd D, Stone SP, MacMahon J. Pharyngeal sensation and gag reflex in healthy subjects. Lancet. 1995;345(8948):487-8.
Valbuza JS, de Oliveira MM, Conti CF, Prado LB, Carvalho LB, do Prado GF. Oropharyngeal examination as a predictor of obstructive sleep apnea: pilot study of gag reflex and palatal reflex. Arq Neuropsiquiatr. 2011;69(5):805-8.
Wu J, Dong J, Ding Y, Zheng J. Role of Anterior Neck Soft Tissue Quantifications by Ultrasound in Predicting Difficult Laryngoscopy. Medical science monitor: international medical journal of experimental and clinical research. 2014;20:2343.
Cormack R, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39(11):1105-11.
Iohom G, Ronayne M, Cunningham A. Prediction of difficult tracheal intubation. European journal of anaesthesiology. 2003;20(01):31-6.
Eberhart LH, Arndt C, Cierpka T, Schwanekamp J, Wulf H, Putzke C. The reliability and validity of the upper lip bite test compared with the Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation. Anesthesia & Analgesia. 2005;101(1):284-9.
Patel B, Khandekar R, Diwan R, Shah A. Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults. Indian journal of anaesthesia. 2014;58(2):171.
Etezadi F, Ahangari A, Shokri H, Najafi A, Khajavi MR, Daghigh M, et al. Thyromental height: a new clinical test for prediction of difficult laryngoscopy. Anesthesia & Analgesia. 2013;117(6):1347-51.
Bergler W, Maleck W, Baker-Schreyer A, Ungemach J, Petroianu G, Hörmann K. [The Mallampati Score. Prediction of difficult intubation in otolaryngologic laser surgery by Mallampati Score]. Der Anaesthesist. 1997;46(5):437-40.
Ali MA, Qamar-ul-Hoda M, Samad K. Comparison of upper lip bite test with Mallampati test in the prediction of difficult intubation at a tertiary care hospital of Pakistan. J Pak Med Assoc. 2012;62(10):1012-5.
Khan ZH, Arbabi S. Diagnostic value of the upper lip bite test in predicting difficulty in intubation with head and neck landmarks obtained from lateral neck X-ray. Indian journal of anaesthesia. 2013;57(4):381.
Rincón DA. Predicting difficult intubation. The Journal of the American Society of Anesthesiologists. 2006;104(3):618-.
Aziz MF, Healy D, Kheterpal S, Fu RF, Dillman D, Brambrink AM. Routine clinical practice effectiveness of the Glidescope in difficult airway management: an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions. Anesthesiology. 2011;114(1):34-41.