Department of Anaesthesia, Critical Care and Pain Management, Hotel-Dieu de France Hospital, Beirut, Lebanon.
Saint-Joseph University Medical School, Beirut, Lebanon.
J Perioper Pract. 2024 Nov;34(11):347-356. doi: 10.1177/17504589231206903. Epub 2023 Dec 19.
We aim to compare the upper lip bite test with the modified Mallampati test as predictors of difficult laryngoscopy and/or difficult intubation among morbidly obese patients.
A total of 500 morbidly obese patients (body mass index > 40 kg/m) undergoing general anaesthesia with tracheal intubation are included in this prospective single-blinded observational clinical study. The preoperative airway assessment is obtained by the modified Mallampati test and upper lip bite test. The difficulty of laryngoscopy is assessed by an experienced anaesthetist in patients adequately anaesthetised and fully relaxed. The view is classified according to Cormack and Lehane's classification. Modified Mallampati test III or IV and upper lip bite test III are considered positive tests. Difficult laryngoscopy is defined as Cormack and Lehane's classification III and IV, whereas difficult endotracheal intubation is defined as an intubation difficulty scale ⩾ 5.
The incidences of Cormack and Lehane's classification III and IV and intubation difficulty scale ⩾ 5 are 9.4% and 11.8% respectively. The specificity, positive predictive value and accuracy are higher with the upper lip bite test. The combination of the upper lip bite test and the modified Mallampati test improved these measures. The likelihood ratio + was significantly higher for the upper lip bite test (6.35 and 9.47) than for the modified Mallampati test (3.21 and 3.16).
The upper lip bite test is a test with high sensitivity, specificity, negative predictive value and accuracy making it a favourable test for identifying easy and difficult intubations and laryngoscopies in morbidly obese patients.
本研究旨在比较上唇咬合试验与改良 Mallampati 试验，以预测病态肥胖患者中困难喉镜检查和/或困难插管的情况。
本前瞻性单盲观察性临床研究共纳入 500 例病态肥胖（BMI>40kg/m²）患者，这些患者均在全身麻醉下进行气管插管。术前气道评估采用改良 Mallampati 试验和上唇咬合试验进行。在充分麻醉和完全放松的患者中，由经验丰富的麻醉师评估喉镜检查的难度。根据 Cormack 和 Lehane 的分类来评估视野。改良 Mallampati 试验 III 或 IV 级和上唇咬合试验 III 级被认为是阳性试验。困难喉镜检查定义为 Cormack 和 Lehane 分级 III 或 IV 级，而困难气管内插管定义为插管困难评分 ⩾5 分。
Cormack 和 Lehane 分级 III 或 IV 级和插管困难评分 ⩾5 分的发生率分别为 9.4%和 11.8%。上唇咬合试验的特异性、阳性预测值和准确性更高。上唇咬合试验与改良 Mallampati 试验相结合提高了这些指标。上唇咬合试验的优势比 (+) 显著高于改良 Mallampati 试验（6.35 和 9.47）。
上唇咬合试验是一种具有高灵敏度、特异性、阴性预测值和准确性的试验，非常适合识别病态肥胖患者中容易和困难的插管和喉镜检查。
