Adamus Milan, Fritscherova Sarka, Hrabalek Lumir, Gabrhelik Tomas, Zapletalova Jana, Janout Vladimir
Department of Anesthesiology and Resuscitation, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010 Dec;154(4):339-43. doi: 10.5507/bp.2010.051.
To determine the accuracy of the modified Mallampati test for predicting difficult tracheal intubation.
A cross-sectional, clinical, observational, non-blinded study. A quality analysis of anesthetic care.
Operating theatres and department of anesthesiology in a university hospital.
Following the local ethics committee approval and patients' informed consent to anesthesia, all adult patients (> 18 yrs) presenting for any type of non-emergency surgical procedures under general anesthesia requiring endotracheal intubation were enrolled. Prior to anesthesia, Samsoon and Young's modification of the Mallampati test (modified Mallampati test) was performed. Following induction, the anesthesiologist described the laryngoscopic view using the Cormack-Lehane scale. Classes 3 or 4 of the modified Mallampati test were considered a predictor of difficult intubation. Grades 3 or 4 of the Cormack-Lehane classification of the laryngoscopic view were defined as impaired glottic exposure. The sensitivity, specificity, positive and negative predictive value, relative risk, likelihood ratio and accuracy of the modified Mallampati test were calculated on 2x2 contingency tables.
Of the total 1,518 patients enrolled, 48 had difficult intubation (3.2%). We failed to detect as many as 35.4% patients in whom glottis exposure during direct laryngoscopy was inadequate (sensitivity 0.646). Compared to the original article by Mallampati, we found lower specificity (0.824 vs. 0.995), lower positive predictive value (0.107 vs. 0.933), higher negative predictive value (0.986 vs. 0.928), lower likelihood ratio (3.68 vs. 91.0) and accuracy (0.819 vs. 0.929).
When used as a single examination, the modified Mallampati test is of limited value in predicting difficult intubation.
确定改良马兰帕蒂试验预测困难气管插管的准确性。
一项横断面、临床、观察性、非盲法研究。麻醉护理质量分析。
大学医院的手术室和麻醉科。
经当地伦理委员会批准并获得患者对麻醉的知情同意后，纳入所有因需要气管插管的全身麻醉进行任何类型非急诊手术的成年患者（>18岁）。麻醉前，进行Samsoon和Young改良的马兰帕蒂试验（改良马兰帕蒂试验）。诱导后，麻醉医生使用Cormack-Lehane分级描述喉镜视野。改良马兰帕蒂试验3级或4级被视为困难插管的预测指标。喉镜视野Cormack-Lehane分级3级或4级被定义为声门暴露受损。在2×2列联表上计算改良马兰帕蒂试验的敏感性、特异性、阳性和阴性预测值、相对风险、似然比和准确性。
在总共纳入的1518例患者中，48例存在插管困难（3.2%）。我们未能检测出多达35.4%的患者在直接喉镜检查时声门暴露不足（敏感性0.646）。与马兰帕蒂的原文相比，我们发现特异性较低（0.824对0.995），阳性预测值较低（0.107对0.933），阴性预测值较高（0.986对0.928），似然比更低（3.68对91.0）和准确性更低（0.819对0.929）。
当作为单一检查使用时，改良马兰帕蒂试验在预测困难插管方面价值有限。
