Abstract
To determine the accuracy of the modified Mallampati test for predicting difficult tracheal intubation. A cross-sectional, clinical, observational, non-blinded study. A quality analysis of anesthetic care. Operating theatres and department of anesthesiology in a university hospital. Following the local ethics committee approval and patients' informed consent to anesthesia, all adult patients (> 18 yrs) presenting for any type of non-emergency surgical procedures under general anesthesia requiring endotracheal intubation were enrolled. Prior to anesthesia, Samsoon and Young's modification of the Mallampati test (modified Mallampati test) was performed. Following induction, the anesthesiologist described the laryngoscopic view using the Cormack-Lehane scale. Classes 3 or 4 of the modified Mallampati test were considered a predictor of difficult intubation. Grades 3 or 4 of the Cormack-Lehane classification of the laryngoscopic view were defined as impaired glottic exposure. The sensitivity, specificity, positive and negative predictive value, relative risk, likelihood ratio and accuracy of the modified Mallampati test were calculated on 2x2 contingency tables. Of the total 1,518 patients enrolled, 48 had difficult intubation (3.2%). We failed to detect as many as 35.4% patients in whom glottis exposure during direct laryngoscopy was inadequate (sensitivity 0.646). Compared to the original article by Mallampati, we found lower specificity (0.824 vs. 0.995), lower positive predictive value (0.107 vs. 0.933), higher negative predictive value (0.986 vs. 0.928), lower likelihood ratio (3.68 vs. 91.0) and accuracy (0.819 vs. 0.929). When used as a single examination, the modified Mallampati test is of limited value in predicting difficult intubation.
Highlights
Difficult/failed intubation is a significant source of morbidity and mortality in surgical patients
If we are able to predict potential difficult intubation during the pre-anesthetic visit, an alternative approach to the airway may be used from the very beginning of anesthesia, so that the risk of hypoxemia associated with difficult intubation is reduced
This study assessed the value of the Mallampati test as a single parameter for predicting impaired glottic exposure during direct laryngoscopy
Summary
Difficult/failed intubation is a significant source of morbidity and mortality in surgical patients. After induction of general anesthesia, adequate oxygenation is impossible (“cannot intubate, cannot ventilate”), urgent cricothyrotomy may be life-saving. Unanticipated difficult intubation can be a surprising and risky operation for the anesthesiologist. All anesthetic departments have guidelines for the management of difficult intubation (“failed-intubation drill”), during any induction of anesthesia, the anesthesiologist must be prepared to handle difficult airways. If we are able to predict potential difficult intubation during the pre-anesthetic visit, an alternative approach to the airway may be used from the very beginning of anesthesia, so that the risk of hypoxemia associated with difficult intubation is reduced. The Mallampati test[1,2] is one of the most frequently used clinical scoring systems to predict difficult intubation. This study assessed the value of the Mallampati test as a single parameter for predicting impaired glottic exposure during direct laryngoscopy
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