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Prediction of difficult tracheal intubation

Published online by Cambridge University Press:  02 June 2005

G. Iohom ,
M. Ronayne  and
A. J. Cunningham
G. Iohom
Affiliation:
Beaumont Hospital, Department of Anaesthesia and Intensive Care, Dublin, Ireland
M. Ronayne
Affiliation:
Beaumont Hospital, Department of Anaesthesia and Intensive Care, Dublin, Ireland
A. J. Cunningham
Affiliation:
Beaumont Hospital, Department of Anaesthesia and Intensive Care, Dublin, Ireland
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Extract

Summary

Background and objective: Preoperative bedside screening tests for difficult tracheal intubation may be neither sensitive nor specific enough for clinical use. The aim was to investigate if a combination of the Mallampati classification of the oropharyngeal view with either the thyromental or sternomental distance measurement improved the predictive value.

Methods: A total of 212 (109 male, 103 female) non-obstetric surgical patients, aged >18 yr, undergoing elective surgical procedures requiring tracheal intubation were assessed preoperatively with respect to the oropharyngeal (modified Mallampati) classification, thyromental and sternomental distances. An experienced anaesthetist, blinded to the preoperative airway assessment, performed laryngoscopy and graded the view according to Cormack and Lehane's classification.

Results: Twenty tracheal intubations (9%) were difficult as defined by a Cormack and Lehane Grade 3 or 4, or the requirement for a bougie in patients with Cormack and Lehane Grade 2. Used alone, the Mallampati oropharyngeal view, and thyromental and sternomental distances were associated with poor sensitivity, specificity and positive predictive values. Combining the Mallampati Class III or IV with either a thyromental distance <6.5 cm or a sternomental distance <12.5 cm decreased the sensitivity (from 40 to 25 and 20%, respectively), but maintained a negative predictive value of 93%. The specificity and positive predictive values increased from 89 and 27% respectively for Mallampati alone to 100%.

Conclusions: The findings suggest that the Mallampati classification, in conjunction with measurement of the thyromental and sternomental distances, may be a useful routine screening test for preoperative prediction of difficult tracheal intubation.

Keywords

ANAESTHETICS, GENERALENDOSCOPY, laryngoscopyINTUBATION, INTRATRACHEALPATIENT CARE, preoperative care
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 1 , January 2003 , pp. 31 - 36
Copyright
© 2003 European Society of Anaesthesiology

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References

Randell T. Prediction of difficult intubation. Acta Anaesthesiol Scand 1996; 42: 136–137.Google Scholar
Voyagis GS, Kyriakis KP, Dimitriou V, Vrettou I. Value of oropharyngeal Mallampati classification in predicting difficult laryngoscopy among obese patients. Eur J Anaesthesiol 1998; 15: 330–334.Google Scholar
Bergler W, Maleck W, Baker-Schreyer A, Ungemach J, Petroianu G, Hormann K. The Mallampati score. Prediction of difficult intubation in otolaryngologic laser surgery by Mallampati score. Anaesthesist 1997; 46: 437–440.Google Scholar
Koay CK. Difficult tracheal intubation-analysis and management in 37 cases. Singapore Med J 1998; 39: 112–114.Google Scholar
Frerk CM. Predicting difficult intubation. Anaesthesia 1991; 46: 1005–1008.Google Scholar
Tse JC, Rimm EB, Hussain A. Predicting difficult endotracheal intubation in surgical patients scheduled for general anaesthesia: a prospective blind study. Anesth Analg 1995; 81: 254–258.Google Scholar
Estebe JP. Prediction of difficult intubation: are we talking about the same thing? Can J Anesth 2001; 48: 719–720.Google Scholar
Savva D. Prediction of difficult intubation. Br J Anaesth 1994; 73: 149–153.Google Scholar
Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–1111.Google Scholar
Langenstein H, Cunitz G. Difficult intubation in adults. Anaesthesist 1996; 45: 372–383.Google Scholar
Ramadhani SAL, Mohamed LA, Rocke DA, Gouws E. Sternomental distance as a sole predictor of difficult laryngoscopy in obstetric anaesthesia. Br J Anaesth 1996; 77: 312–316.Google Scholar
Williams KN, Carli F, Cormack RS. Unexpected difficult laryngoscopy: a prospective survey in routine general surgery. Br J Anaesth 1991; 66: 38–44.Google Scholar
Higashizawa T, Bito H, Nishiyama T, Sakai T, Konishi A. Assessment of the practice of endotracheal intubation by levering laryngoscope in teaching of undergraduate medical students. Masui 1997; 46: 1255–1258.Google Scholar
Naguib M, Malabarey T, AlSatli RA, Al Damegh S, Samarkandi AH. Predictive models for difficult laryngoscopy and intubation. A clinical, radiologic and three-dimensional computer imaging study. Can J Anesth 1999; 46: 748–759.Google Scholar
Duchynski R, Brauer K, Hutton K, Jones S, Rosen P. The Quick Look Airway Classification: a useful tool in predicting the difficult out-of-hospital intubation: experience in air medical transport program. Air Med J 1998; 17: 46–50.Google Scholar
Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–434.Google Scholar
Patil VU, Stehling LC, Zaunder HL. Fibreoptic Endoscopy in Anaesthesia. Chicago, USA: Year Book, 1983.
Butler PJ, Dhara SS. Prediction of difficult laryngoscopy: an assessment of the thyromental distance and Mallampati predictive tests. Anaesth Inten Care 1992; 20: 139–142.Google Scholar
Chou H-C, Wu T-L. Thyromental distance – shouldn't we redefine its role in the prediction of difficult laryngoscopy? Acta Anaesthesiol Scand 1998; 42: 136–137.Google Scholar