Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation

Venkateshamurthy Banavara Champa; Venkappa Yashoda; Nagarajarao Karnalli Gurudutta

doi:doi:10.11648/j.ijacm.20200801.11

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Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation

Venkateshamurthy Banavara Champa, Venkappa Yashoda, Nagarajarao Karnalli Gurudutta

Published in International Journal of Anesthesia and Clinical Medicine (Volume 8, Issue 1)

Received: 19 August 2019 Accepted: 12 November 2019 Published: 19 February 2020

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Abstract

Difficult airway remains a potential problem for practicing anaesthesiologists. Modified mallampati test alone has low sensitivity and specificity. Preoperative assessment of the airway using a combination of simple tests will increase the sensitivity and specificity of prediction of difficult airway than using a single parameter alone. This study was done to compare the sensitivity, specificity and accuracy for preoperative prediction of difficult endotracheal intubation in adults undergoing elective surgeries using combination of Modified Mallampati test [MMT], Sternomental distance [SMD], Thyromental distance [TMD] and Neck mobility [NM] over MMT alone and to assess whether MMT alone or in combination with TMD, SMD and NM is a better predictor of difficult laryngoscopy. This is a prospective observational study. 100 patients undergoing elective surgeries under general anaesthesia were enrolled into two groups. Group 1 was the MMT group and Group 2 was the MMT, TMD, SMD & NM Group. Results were analysed using SPSS software Version 12 and STATA used for analysing the sensitivity, specificity, PPV, NPV and accuracy in each group. P value calculated using Chi Square test. Group 1 had lower sensitivity, specificity, PPV, NPV as well as Accuracy when compared with that of Group 2. The combination of the parameters yielded a greater accuracy in predicting the difficult intubation stressing the importance of assessing the evaluation of other parameters like TMD, SMD & NM along with MMD for successful prediction of a difficult endotracheal intubation. In conclusion the MMT alone in preoperative assessment of difficult laryngoscopy is less sensitive. The combination of MMT, TMD, SMD & NM is more sensitive as well as specific to predict a difficult intubation than using MMT alone in the pre-operative period.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 8, Issue 1) This article belongs to the Special Issue Anesthesia for Laparoscopic Surgery
DOI	10.11648/j.ijacm.20200801.11
Page(s)	1-5
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Cormack Lehane (C-L) Grading, Difficult Intubation, Modified Mallampatitest (MMT), Neck Mobility (NM), Sternomental Distance (SMD), Thyromental Distance (TMD)

References

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[2]	Rudolph C, Henn-Beilharz A, Gottschall R, Wallenborn J, Schaffranietz L. The unanticipated difficult intubation: rigid or flexible endoscope? Minerva Anestesiol 2007; 73: 567-574.
[3]	Khan RM. Airway assessment. In: Khan RM editor. Airway Management. 4th ed. Hydrabad: Paras Medical Publisher; 2011. p. 14.
[4]	Biomed Pap Med FacUnivPalacky Olomouc Czech Repub. 2010 Dec; 154 (4): 339–344.
[5]	Mallampati SR: Recognition of the difficult airway. In Benumof JL, editor: Airway management principles and practice, St Louis, 1996, Mosby, p. 132.
[6]	Patil VU, Stehling LC, Zauder HL. Predicting the difficulty of intubation utilizing an intubation guide. Anaesthesiology, 1983; 10: 32.
[7]	Savva D. Prediction of difficult tracheal intubation. Br J Anaesth 1994; 73: 149-153.
[8]	Banister FB, Mc Beth RG. Direct laryngoscopy and tracheal intubation. Lancet 1964; 2: 651.
[9]	Cormack RS, Lehane J: Difficult tracheal intubation in obstetrics, Anaesthesia 39: 1105, 1984; and Williams KN, Carli F, Cormack RS: Unexpected difficult laryngoscopy: a prospective survey in routine general surgery, Br J Anaesth 66: 38, 1991.
[10]	Khan RM. Airway assessment. In: Khan RM editor. Airway Management. 5th ed. Hydrabad: Paras Medical Publisher; 2015. p. 2.
[11]	American Society of Anesthesiologists: Practice guidelines for management of the difficult airway: an updated report. Anesthesiology 2003; 98: 1269-1277.
[12]	Mallampati SR. Clinical sign to predict difficult tracheal intubation (hypothesis). Can AnaesthSoc J 1983; 30: 316 7.
[13]	Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, et al. A clinical sign to predict difficult tracheal intubation: A prospective study. Can AnaesthSoc J 1985; 32: 429 34.
[14]	SangeetaDhangere, SumanLta Gupta, et al Diagnostic accuracy of bedside tests for predicting difficult intubation in Indian population: An observational study, Anesth Essays Res 2016 Jan-Apr; 10 (1): 54–58.
[15]	Wajekar AS, Chellam S, Toal PV. Prediction of ease of laryngoscopy and intubation-role of upper lip bite test, modified mallampati classification, and thyromental distance in various combination. J Fam Med Primary Care 2015; 4: 101-5.
[16]	Honarmand A, Safavi M, Ansari N. A comparison of between hyomental distance ratios, ratio of height to thyromental, modified Mallamapati classification test and upper lip bite test in predicting difficult laryngoscopy of patients undergoing general anesthesia. Adv Biomed Res 2014; 3: 166.
[17]	Sushil Prakash Ambesh, Neha Singh, ParnandiBhaskar Rao, Devendra Gupta, Prabhat Kumar Singh, Uttam Singh. A combination of the modified Mallampati score, thyromental distance, anatomical abnormality, and cervical mobility (M-TAC) predicts difficult laryngoscopy better than Mallampati classification. Acta Anesthesia Taiwan 2013 Jun; 51 (2): 58-62. doi: 10.1016/j.aat.2013.06.005. Epub 2013 Jul 21.
[18]	M. Adamus, S. Fritscherova, L. Hrabalek, T. Gabrhelik, J. Zapletalova, V. Janout. Mallampati test as a predictor of laryngoscopic view. Biomed Pap Med FacUnivPalacky Olomouc Czech Repub. 2010 Dec; 154 (4): 339–344.

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Venkateshamurthy Banavara Champa, Venkappa Yashoda, Nagarajarao Karnalli Gurudutta. (2020). Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation. International Journal of Anesthesia and Clinical Medicine, 8(1), 1-5. https://doi.org/10.11648/j.ijacm.20200801.11

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ACS Style

Venkateshamurthy Banavara Champa; Venkappa Yashoda; Nagarajarao Karnalli Gurudutta. Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation. Int. J. Anesth. Clin. Med. 2020, 8(1), 1-5. doi: 10.11648/j.ijacm.20200801.11

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AMA Style

Venkateshamurthy Banavara Champa, Venkappa Yashoda, Nagarajarao Karnalli Gurudutta. Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation. Int J Anesth Clin Med. 2020;8(1):1-5. doi: 10.11648/j.ijacm.20200801.11

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@article{10.11648/j.ijacm.20200801.11,
  author = {Venkateshamurthy Banavara Champa and Venkappa Yashoda and Nagarajarao Karnalli Gurudutta},
  title = {Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {8},
  number = {1},
  pages = {1-5},
  doi = {10.11648/j.ijacm.20200801.11},
  url = {https://doi.org/10.11648/j.ijacm.20200801.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20200801.11},
  abstract = {Difficult airway remains a potential problem for practicing anaesthesiologists. Modified mallampati test alone has low sensitivity and specificity. Preoperative assessment of the airway using a combination of simple tests will increase the sensitivity and specificity of prediction of difficult airway than using a single parameter alone. This study was done to compare the sensitivity, specificity and accuracy for preoperative prediction of difficult endotracheal intubation in adults undergoing elective surgeries using combination of Modified Mallampati test [MMT], Sternomental distance [SMD], Thyromental distance [TMD] and Neck mobility [NM] over MMT alone and to assess whether MMT alone or in combination with TMD, SMD and NM is a better predictor of difficult laryngoscopy. This is a prospective observational study. 100 patients undergoing elective surgeries under general anaesthesia were enrolled into two groups. Group 1 was the MMT group and Group 2 was the MMT, TMD, SMD & NM Group. Results were analysed using SPSS software Version 12 and STATA used for analysing the sensitivity, specificity, PPV, NPV and accuracy in each group. P value calculated using Chi Square test. Group 1 had lower sensitivity, specificity, PPV, NPV as well as Accuracy when compared with that of Group 2. The combination of the parameters yielded a greater accuracy in predicting the difficult intubation stressing the importance of assessing the evaluation of other parameters like TMD, SMD & NM along with MMD for successful prediction of a difficult endotracheal intubation. In conclusion the MMT alone in preoperative assessment of difficult laryngoscopy is less sensitive. The combination of MMT, TMD, SMD & NM is more sensitive as well as specific to predict a difficult intubation than using MMT alone in the pre-operative period.},
 year = {2020}
}

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TY - JOUR
T1 - Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation
AU - Venkateshamurthy Banavara Champa
AU - Venkappa Yashoda
AU - Nagarajarao Karnalli Gurudutta
Y1 - 2020/02/19
PY - 2020
N1 - https://doi.org/10.11648/j.ijacm.20200801.11
DO - 10.11648/j.ijacm.20200801.11
T2 - International Journal of Anesthesia and Clinical Medicine
JF - International Journal of Anesthesia and Clinical Medicine
JO - International Journal of Anesthesia and Clinical Medicine
SP - 1
EP - 5
PB - Science Publishing Group
SN - 2997-2698
UR - https://doi.org/10.11648/j.ijacm.20200801.11
AB - Difficult airway remains a potential problem for practicing anaesthesiologists. Modified mallampati test alone has low sensitivity and specificity. Preoperative assessment of the airway using a combination of simple tests will increase the sensitivity and specificity of prediction of difficult airway than using a single parameter alone. This study was done to compare the sensitivity, specificity and accuracy for preoperative prediction of difficult endotracheal intubation in adults undergoing elective surgeries using combination of Modified Mallampati test [MMT], Sternomental distance [SMD], Thyromental distance [TMD] and Neck mobility [NM] over MMT alone and to assess whether MMT alone or in combination with TMD, SMD and NM is a better predictor of difficult laryngoscopy. This is a prospective observational study. 100 patients undergoing elective surgeries under general anaesthesia were enrolled into two groups. Group 1 was the MMT group and Group 2 was the MMT, TMD, SMD & NM Group. Results were analysed using SPSS software Version 12 and STATA used for analysing the sensitivity, specificity, PPV, NPV and accuracy in each group. P value calculated using Chi Square test. Group 1 had lower sensitivity, specificity, PPV, NPV as well as Accuracy when compared with that of Group 2. The combination of the parameters yielded a greater accuracy in predicting the difficult intubation stressing the importance of assessing the evaluation of other parameters like TMD, SMD & NM along with MMD for successful prediction of a difficult endotracheal intubation. In conclusion the MMT alone in preoperative assessment of difficult laryngoscopy is less sensitive. The combination of MMT, TMD, SMD & NM is more sensitive as well as specific to predict a difficult intubation than using MMT alone in the pre-operative period.
VL - 8
IS - 1
ER -

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Author Information

Venkateshamurthy Banavara Champa

Department of Anaesthesiology, Shivamogga Institute of Medical Sciences, Shivamogga, India
Venkappa Yashoda

Department of Anaesthesiology, Shivamogga Institute of Medical Sciences, Shivamogga, India
Nagarajarao Karnalli Gurudutta

Department of Anaesthesiology, Shivamogga Institute of Medical Sciences, Shivamogga, India

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APA Style

Venkateshamurthy Banavara Champa, Venkappa Yashoda, Nagarajarao Karnalli Gurudutta. (2020). Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation. International Journal of Anesthesia and Clinical Medicine, 8(1), 1-5. https://doi.org/10.11648/j.ijacm.20200801.11

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ACS Style

Venkateshamurthy Banavara Champa; Venkappa Yashoda; Nagarajarao Karnalli Gurudutta. Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation. Int. J. Anesth. Clin. Med. 2020, 8(1), 1-5. doi: 10.11648/j.ijacm.20200801.11

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AMA Style

Venkateshamurthy Banavara Champa, Venkappa Yashoda, Nagarajarao Karnalli Gurudutta. Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation. Int J Anesth Clin Med. 2020;8(1):1-5. doi: 10.11648/j.ijacm.20200801.11

Copy | Download

@article{10.11648/j.ijacm.20200801.11,
  author = {Venkateshamurthy Banavara Champa and Venkappa Yashoda and Nagarajarao Karnalli Gurudutta},
  title = {Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {8},
  number = {1},
  pages = {1-5},
  doi = {10.11648/j.ijacm.20200801.11},
  url = {https://doi.org/10.11648/j.ijacm.20200801.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20200801.11},
  abstract = {Difficult airway remains a potential problem for practicing anaesthesiologists. Modified mallampati test alone has low sensitivity and specificity. Preoperative assessment of the airway using a combination of simple tests will increase the sensitivity and specificity of prediction of difficult airway than using a single parameter alone. This study was done to compare the sensitivity, specificity and accuracy for preoperative prediction of difficult endotracheal intubation in adults undergoing elective surgeries using combination of Modified Mallampati test [MMT], Sternomental distance [SMD], Thyromental distance [TMD] and Neck mobility [NM] over MMT alone and to assess whether MMT alone or in combination with TMD, SMD and NM is a better predictor of difficult laryngoscopy. This is a prospective observational study. 100 patients undergoing elective surgeries under general anaesthesia were enrolled into two groups. Group 1 was the MMT group and Group 2 was the MMT, TMD, SMD & NM Group. Results were analysed using SPSS software Version 12 and STATA used for analysing the sensitivity, specificity, PPV, NPV and accuracy in each group. P value calculated using Chi Square test. Group 1 had lower sensitivity, specificity, PPV, NPV as well as Accuracy when compared with that of Group 2. The combination of the parameters yielded a greater accuracy in predicting the difficult intubation stressing the importance of assessing the evaluation of other parameters like TMD, SMD & NM along with MMD for successful prediction of a difficult endotracheal intubation. In conclusion the MMT alone in preoperative assessment of difficult laryngoscopy is less sensitive. The combination of MMT, TMD, SMD & NM is more sensitive as well as specific to predict a difficult intubation than using MMT alone in the pre-operative period.},
 year = {2020}
}

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