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Analysis Study Research Paper | Anaesthesiology | India | Volume 12 Issue 3, March 2023
A Study on Non - Invasive Airway Assessment Techniques in Predicting Difficult Intubation
Dr. P. Mounika
Abstract: Introduction: Airway assessment is the first step in successful airway management. Several anatomical and functional maneuvers can be performed to estimate the difficulty of endotracheal intubation. We aimed to elucidate the role of upper lip bite test (ULBT), Modifies Mallamati Test (MMT), Wilsons risk score (WRS), Thyromental distance (TMD), Sternomental length (SMD) and their correlation in predicting difficulty intubation in relation to laryngoscopic view as per Cormack Lehane (CL) grading. Methods: An observational study has been conducted on 100 subjects aged between 18 to 65 who were posted for elective surgeries requiring general anaesthesia with endotracheal intubation. In the study, we assessed the predictive power of 5 (five) pre - operative tests: Modified Mallampati Test (MMT), Thyromental Distance (TMD), Sternomental Distance (SMD), Upper Lip Bite Test (ULBT) and Wilsons score to detect Difficult Visualization of Larynx (DVL) which in turn can be used for the prediction of difficult intubation. Results: The sensitivity of MMT, ULBT, WRS, TMD, SMD in our study is 92.5%, 100%, 77.5%, 17.5%, 57.5% respectively. The above study states the Negative Predictive Value (NPV) and Positive Predictive Value (PPV) of WRS were found to be 86.6% and 93.9% respectively. Specificities of ULBT, MMT, TMD, SMD and WRS were found to be 1.7%, 53.3%, 73.3%, 100% and 96.7% respectively. Thus when we compared all the five tests, i. e., Modified Mallampati Test (MMT), Upper Lip Bite Test (ULBT), Wilsons risk score (WRS), Thyromental distance (TMD), and Sternomental length (SMD) for the prediction of Difficult Visualization of Larynx (DVL), it was found that Upper Lip Bite Test (ULBT) was the most sensitive (100%). Sternomental distance (SMD) was the most specific (100%). However, it was found that Modified Mallampati Test (MMT), Upper Lip Bite Test (ULBT), Wilsons risk score (WRS), and Sternomental distance (SMD) had a p - value < 0.01, hence significant in the prediction of difficult visualization of the larynx (DVL). Conclusion: Upper Lip Bite Test (ULBT) was the most sensitive (100%), and Sternomental distance was the most specific (100%). Wilsons score had a significant sensitivity, specificity, positive predictive value, and negative predictive value. Wilsons' score, being a multi - parameter scoring system, is the best predictor of the Difficult Visualization of Larynx and thus difficult intubation.
Keywords: ULBT, MMT, TMD, SMD, WRS, CL Grading, Difficult intubation
Edition: Volume 12 Issue 3, March 2023,
Pages: 989 - 995