Kar Supriya, Senapati Laxman K, Samanta Priyadarsini, Satapathy Ganesh C
Anesthesiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Physiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Cureus. 2022 Sep 3;14(9):e28754. doi: 10.7759/cureus.28754. eCollection 2022 Sep.
Background and objective Many tests are at hand to predict difficult intubation preoperatively to prevent morbidity and mortality of unanticipated difficult intubation. The present study was conducted to evaluate and compare the efficacy of the modified Mallampati test (MMT) and upper lip bite test (ULBT) to foresee difficult intubation. Materials and methods After obtaining written informed consent, this prospective comparative observational study was conducted on 225 patients scheduled for elective surgery under general endotracheal anesthesia. Preoperative MMT and ULBT were performed. MMT Grade III, IV, and ULBT Grade IV were regarded as predictors of difficult intubation. The laryngoscopic view was graded as per Cormack and Lehane's laryngoscopic grading after induction of anesthesia by an experienced anesthesiologist ignorant of preoperative airway evaluation. Patients with Cormack and Lehane Class III and IV were regarded as difficult intubation. Sensitivity, specificity, and positive and negative predictive values of MMT and ULBT were computed. Agreement between two tests with the Cormack Lehane test was determined by the Kappa coefficient. Results In our research, the occurrence of difficult intubation was found to be 10.2% (23 cases of difficult intubation out of 225 patients). In our analysis, we found the sensitivity (95.5% vs. 95.4%), specificity (54.8% vs 50.0%), positive predictive value (91.6% vs 93.1%), and negative predictive value (39.1% vs 39.1%) were almost comparable between modified Mallampati test and upper lip bite test. Kappa coefficient for the upper lip bite test (0.492) was slightly higher as compared to modified Mallampati scoring (0.454), but both the values are highly statistically significant (p-value <0.001). Conclusion Both the upper lip bite test and modified Mallampati test are comparable with each other and since the upper lip bite test is easy to perform bedside test we recommend it to be used alone or in collaboration with other tests in assessing difficult airways.
背景与目的 目前有多种检查方法可用于术前预测困难气道插管，以预防意外困难气道插管导致的发病和死亡。本研究旨在评估和比较改良马兰帕蒂试验（MMT）和上唇咬试验（ULBT）预测困难气道插管的效果。
材料与方法 在获得书面知情同意后，对225例计划在全身气管内麻醉下进行择期手术的患者进行了这项前瞻性比较观察研究。术前进行MMT和ULBT。MMTⅢ级、Ⅳ级以及ULBTⅣ级被视为困难气道插管的预测指标。由一位不了解术前气道评估情况的经验丰富的麻醉医生在麻醉诱导后，根据科马克和莱汉内喉镜分级法对喉镜视野进行分级。科马克和莱汉内Ⅲ级和Ⅳ级的患者被视为困难气道插管。计算MMT和ULBT的敏感性、特异性、阳性预测值和阴性预测值。通过kappa系数确定两种检查与科马克 - 莱汉内试验之间的一致性。
结果 在我们的研究中，发现困难气道插管的发生率为10.2%（225例患者中有23例困难气道插管）。在我们的分析中，我们发现改良马兰帕蒂试验和上唇咬试验之间的敏感性（95.5%对95.4%）、特异性（54.8%对50.0%）、阳性预测值（91.6%对93.1%）和阴性预测值（39.1%对39.1%）几乎相当。上唇咬试验的kappa系数（0.492）比改良马兰帕蒂评分（0.454）略高，但两个值均具有高度统计学意义（p值<0.001）。
结论 上唇咬试验和改良马兰帕蒂试验相互可比，并且由于上唇咬试验是一种易于在床边进行的检查，我们建议在评估困难气道时单独使用或与其他检查联合使用。
