VALIDITY OF CERTAIN BEDSIDE TESTS IN PREDICTING DIFFICULT ENDOTRACHEAL INTUBATION

Jasim Salman,Sadad Salman,Salam Asfar

doi:10.33762/bsurg.2019.163769

Abstract

Unexpected difficult endotracheal intubation remains the main concern of anesthesiologists. This study aimed to compare validity and role of 7 bedside techniques of assessment used in predicting difficult intubation. This prospective study included 80 patients scheduled for surgery. Before induction of anesthesia, bedside tests for predicting difficult intubation were done, these tests are: Prayer sign, Thyromental distance, Mallampati test, The inter incisor distance, Palm print test, Upper lip bite test, and Wilson scoring system. During induction of anesthesia, laryngoscopic view was evaluated. Values for each test were calculated and compared. The results showed that, the highest sensitivity (62.5%) was for Mallampati and thyromental distance but despite that, they differed in their specificity and predictive values. Upper lip bite was 12.5% sensitive but had one of the highest specificity alongside with Mallampati test. Thyromental distance was 34.7% specific. Mallampati classes of more than class I was strongly associated with difficult intubation. The mouth gap of more than 4 cm was marginally associated with difficult intubation. The predictor Wilson showed a significant association with difficult intubation if the score exceeded 3.5. The upper lip bite of more than class I was slightly associated with difficult intubation. In conclusion, Mallampati classification and thyromental distance are superior to other available tests to predict difficult intubation, performing these two tests alone is relatively adequate to predict intubation difficulty. Keywords: Difficult endotracheal intubation, The inter incisor distance, Wilson scoring system, Mallampati test, Palm print test, Prayer sign, Upper lip bite test, and Thyromental distance.

Highlights

The trip to get into the trachea successfully is accompanied by a lot of events that one may expect anything; any prior anticipation is wise
Patients & Methods This prospective study was conducted on 80 adult patients American Society of Anesthesiologists (ASA) physical status classes I and II who were presented for elective surgery under general anesthesia with endotracheal intubation in Basrah Teaching Hospital in the period of January to December 2018
The validity of different predictors is presented in table IV showing the highest sensitivity (62.5%) was for Mallampati and thyromental distance with variable specificity 91.6 % and 34.7% respectively

Summary

Introduction

The trip to get into the trachea successfully is accompanied by a lot of events that one may expect anything; any prior anticipation is wise. Such expectancy can be achieved by taking a thorough history and performing specific bedside examinations to act against the worry of unexpected intubation difficulty. Assessment of anatomical and pathological difficulties can be done by a variety of tests: The prayer sign: patients who are unable to completely oppose their hands (with no space between) or approximate the palmar surfaces of the interphalangeal joints due to stiff joint syndrome should be suspected to have changes in other joints and will potentially have difficult laryngoscopy and endotracheal intubation1.2. A distance greater than 3 fingerbreadths is desirable for easy intubation[3 ].

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Conclusion