Bindra Ashish, Prabhakar Hemanshu, Bithal Parmod K, Singh Gyaninder Pal, Chowdhury Tumul
Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2013 Apr;29(2):187-90. doi: 10.4103/0970-9185.111694.
There are numerous reports of difficult laryngoscopy and intubation in patients with acromegaly. To date, no study has assessed the application of extended Mallampati score (EMS) for predicting difficult intubation in acromegalics. The primary aim of this study was to compare EMS with modified Mallampati classification (MMP) in predicting difficult laryngoscopy in acromegalic patients. We hypothesized that since EMS has been reported to be more specific and better predictor than MMP, it may be superior to the MMP to predict difficult laryngoscopy in acromegalic patients.
For this prospective cohort study with matched controls, acromegalic patients scheduled to undergo pituitary surgery over a period of 3 years (January 2008-December 2010) were enrolled. Preoperative airway assessment was performed by experienced anesthesiologists and involved a MMP and the EMS. Under anesthesia, laryngoscopic view was assessed using Cormack-Lehane (CL) grading. MMP and CL grades of I and II were defined "easy" and III and IV as "difficult". EMS grade of I and II were defined "easy" and III as "difficult". Data were used to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MMP and EMS in predicting difficult laryngoscopy.
Seventy eight patients participated in the study (39 patients in each group). Both MMP and EMS failed to detect difficult laryngoscopy in seven patients. Only one laryngoscopy was predicted to be difficult by both tests which was in fact, difficult.
We found that addition of neck extension did not improve the predictive value of MMP.
有大量关于肢端肥大症患者喉镜检查和插管困难的报道。迄今为止，尚无研究评估扩展的马兰帕蒂评分（EMS）在预测肢端肥大症患者插管困难方面的应用。本研究的主要目的是比较EMS与改良马兰帕蒂分类（MMP）在预测肢端肥大症患者喉镜检查困难方面的效果。我们假设，由于据报道EMS比MMP更具特异性且预测性更好，在预测肢端肥大症患者喉镜检查困难方面可能优于MMP。
对于这项有匹配对照的前瞻性队列研究，纳入了计划在3年期间（2008年1月至2010年12月）接受垂体手术的肢端肥大症患者。由经验丰富的麻醉医生进行术前气道评估，包括MMP和EMS。在麻醉下，使用科马克-莱汉内（CL）分级评估喉镜视野。MMP和CL分级为I级和II级定义为“容易”，III级和IV级定义为“困难”。EMS分级为I级和II级定义为“容易”，III级定义为“困难”。数据用于确定MMP和EMS在预测喉镜检查困难方面的敏感性、特异性、阳性预测值、阴性预测值和准确性。
78名患者参与了研究（每组39名患者）。MMP和EMS均未能在7名患者中检测到喉镜检查困难。两项检查仅预测了一次喉镜检查困难，而实际情况确实困难。
我们发现增加颈部伸展并不能提高MMP的预测价值。
