Singha Dheeraj, Kattimani Milind Masuta, Kanwar Manjeet, Bhandari Shyam, Singh Jai
Department of Anaesthesia, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India.
Department of Anaesthesia, Shri BM Patil Medical College, Vijaypura, Karnataka, India.
Saudi J Anaesth. 2023 Apr-Jun;17(2):163-167. doi: 10.4103/sja.sja_438_22. Epub 2023 Mar 10.
Positioning of patients during surgery, whether prone or head down, can lead to airway edema which, in turn, may lead to a difficult airway, and enhanced chances for reintubation. We aimed to assess and evaluate modified Mallampati class (MMC) change in patients scheduled for lumbar spine surgery in the prone position.
This prospective observational study included 80 patients scheduled for lumbar spine surgery. The MMC was assessed up to 48 h postoperatively. The time taken by the patients in the postoperative period for MMC class to revert to preoperative value and airway complications, if any, was noted. Other parameters observed were surgical duration, intraoperative fluids used, and blood loss to look for any significant correlation with changes in MMC.
MMC increase by one grade was observed in 73 patients (91%). MMC in 54 patients (74%) returned to baseline within 18 h, in 12 patients (16%) it took 24 h, and in the remaining 7 patients (10%) the time taken was 36 h.
It was concluded and established by this study that the MMC declined by one grade and reverted to baseline value within 36 h. This change in MMC necessitates extra caution to be adopted during the postoperative period as surgery in a prone position may predispose to an increased risk of encountering difficult reintubation. The change in MMC was not significantly correlated to intraoperative variables like duration of surgery, amount of intraoperative fluid given, and blood loss.
手术期间患者的体位，无论是俯卧位还是头低位，都可能导致气道水肿，进而可能导致气道困难以及再次插管的几率增加。我们旨在评估和评价计划行俯卧位腰椎手术患者的改良马兰帕蒂分级（MMC）变化。
这项前瞻性观察性研究纳入了80例计划行腰椎手术的患者。术后48小时内评估MMC。记录患者术后MMC分级恢复到术前值所需的时间以及气道并发症（如有）。观察的其他参数包括手术时长、术中使用的液体量和失血量，以寻找与MMC变化的任何显著相关性。
73例患者（91%）观察到MMC升高一级。54例患者（74%）的MMC在18小时内恢复到基线，12例患者（16%）需要24小时，其余7例患者（10%）所需时间为36小时。
本研究得出并确定，MMC下降一级并在36小时内恢复到基线值。MMC的这种变化需要在术后格外小心，因为俯卧位手术可能会增加再次插管困难的风险。MMC的变化与手术时长、术中补液量和失血量等术中变量无显著相关性。
