Harjai Mamta, Alam Sharif, Bhaskar Priyesh
Department of Anesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND.
Department of Anaesthesiology, Career Institute of Medical Sciences and Hospital, Lucknow, IND.
Cureus. 2021 Jul 14;13(7):e16396. doi: 10.7759/cureus.16396. eCollection 2021 Jul.
Background and aims Management of difficult airway can be associated with serious morbidity and mortality and it is a basic and serious concern for anesthesiologists. The preoperative airway assessment is done by using conventional clinical predictors. The present study was conducted to find the correlation of various new clinical predictors with the Cormack-Lehane (CL) grade at the laryngoscopic view in patients undergoing general anesthesia with endotracheal intubation. Settings and design The prospective, comparative, observational, double-blind study was carried at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow. Materials and methods The study was conducted in 150 patients undergoing elective surgery under general anaesthesia. The primary outcome was the measurement of clinical airway assessment preoperatively based on certain parameters (inter incisor gap (IIG), modified Mallampati grading (MPG), neck circumference/thyromental distance (NC/TMD), ratio of height to thyromental distance (RHTMD)). The secondary outcome was the correlation of clinical airway assessment with CL grading to predict difficult intubation. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of the parameters were assessed. Statistical analysis The association between different predictors and difficult laryngoscopy was evaluated using binary univariate logistic regression and multivariate logistic regression and the significant clinical predictors were assessed by using Pearson's correlation. A p-value of < 0.05 was considered significant. Results The incidence of difficult intubation in this study was 13.3%. Among the clinical predictors, the Mallampati grading has the maximum receiver operating characteristic (ROC) and area under the curve (AUC) with 86.7 % sensitivity to predict difficult laryngoscopy followed by NC/TMD and body mass index. Conclusion Modified Mallampati grading still holds its significant value among new predictors in the assessment of difficult laryngoscopy.
背景与目的 困难气道的管理可能与严重的发病率和死亡率相关，这是麻醉医生基本且严重关切的问题。术前气道评估通过使用传统临床预测指标来进行。本研究旨在探寻在接受气管插管全身麻醉的患者中，各种新的临床预测指标与喉镜直视下的科马克-莱汉内（CL）分级之间的相关性。
设置与设计 本前瞻性、对比性、观察性、双盲研究在勒克瑙的拉姆·马诺哈尔·洛希亚医学科学研究所开展。
材料与方法 本研究纳入了150例接受全身麻醉下择期手术的患者。主要结局是术前基于某些参数（门齿间距（IIG）、改良马兰帕蒂分级（MPG）、颈围/颏甲距离（NC/TMD）、身高与颏甲距离之比（RHTMD））进行临床气道评估。次要结局是临床气道评估与CL分级之间的相关性，以预测困难插管。评估了各参数的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
统计分析 使用二元单变量逻辑回归和多变量逻辑回归评估不同预测指标与困难喉镜检查之间的关联，并通过Pearson相关性评估显著的临床预测指标。p值<0.05被认为具有统计学意义。
结果 本研究中困难插管的发生率为13.3%。在临床预测指标中，马兰帕蒂分级具有最大的受试者工作特征（ROC）和曲线下面积（AUC），预测困难喉镜检查的敏感性为86.7%，其次是NC/TMD和体重指数。
结论 在困难喉镜检查评估的新预测指标中，改良马兰帕蒂分级仍具有重要价值。
