Mallampati Research Articles

Endotracheal Intubation with King Vision Video Laryngoscope vs Macintosh Direct Laryngoscope in ICU: A Comparative Evaluation of Performance and Outcomes.

Endotracheal intubation to protect airway patency in critically ill patients with the use of videolaryngoscopes has been emerging and their expertise to handle is crucial. Our study focuses on the performance and outcomes of King Vision video laryngoscope (KVVL) in intensive care unit (ICU) compared to Macintosh direct laryngoscope (DL). This comparative study was conducted by randomizing 143 critically ill patients in ICU into two groups: KVVL and Macintosh DL (n = 73; n = 70). The intubation difficulty was assessed by Mallampati score III or IV, apnea syndrome (obstructive), cervical spine limitation, opening mouth <3 cm, coma, hypoxia, anesthesiologist nontrained (MACOCHA) score. The primary endpoint was the glottic view measured by Cormack-Lehane (CL) grading. The secondary endpoints were a first-pass success, the time required for intubation, airway morbidities, and manipulations required. The KVVL group showed the primary endpoint of significantly improved glottic visualization measured in terms of CL grading compared with the Macintosh DL group (p < 0.001). In the KVVL group, the first pass success rate was higher (95.7%) compared to the Macintosh DL group (81.4%) (p < 0.05). The time required for intubation in the KVVL group (28.77 ± 2.63 seconds) was significantly less compared with Macintosh DL (38.84 ± 2.72 seconds) group (p < 0.001). The airway morbidities observed were similar in both groups (p = 0.5) and the manipulation required for endotracheal intubation was significantly less (p < 0.05) in our KVVL group (16 cases; 23%) compared to the Macintosh DL group (8 cases; 10%). We found that the performance and outcomes of KVVL in intubating critically ill ICU patients were promising when handled by experienced operators who are experts in anesthesiology and airway management. Dharanindra M, Jedge PP, Patil VC, Kulkarni SS, Shah J, Iyer S, et al. Endotracheal Intubation with King Vision Video Laryngoscope vs Macintosh Direct Laryngoscope in ICU: A Comparative Evaluation of Performance and Outcomes. Indian J Crit Care Med 2023;27(2):101-106.

Evaluation of Palm Print Sign and Prayer Sign in Prediction of Difficult Laryngoscopy in Diabetic Patients.

Laryngoscopy or endotracheal intubation in diabetic patients due to impaired mobility of the Atlanto-occipital joint owing to non-enzymatic glycosylation in connective tissue has always been a problem. A difficult laryngoscopy can disrupt the intubation process; therefore, it is valuable to predict difficult laryngoscopy using some anatomical criteria before general anesthesia. The present study discussed the diagnostic value of two tests, palm print sign and prayer sign, in the prediction of laryngoscopy difficulty. Design: A diagnostic test and cross-sectional analytical design were used in this study. Setting: The study population included 200 patients with type 2 diabetes who were candidates for surgery under general anesthesia. Before surgery, the patients were examined regarding the airway status, Mallampati classification, head extension rate, thyromental distance, body mass index, upper lip biting test, and two palm print sign and prayer sign tests. All the diagnostic tests were compared to the Cormack test result for difficult airways regarding their sensitivity and specificity in difficult laryngoscopy. The highest sensitivity was related to the Mallampati test, prayer sign test, and palm print sign test (100%). Furthermore, the mouth-opening test had the highest specificity (100%). The highest accuracy was reported for Mallampati, palm print sign, and prayer sign tests (> 86%). Among the tests studied to predict difficulty in laryngoscopy in diabetic patients, Mallampati and palm print sign tests have good sensitivity, specificity, and accuracy. Studies with a larger sample size are suggested to obtain more accurate results.

Comparison of Tritube™ tube and Evone® ventilator use with traditional narrow-lumen tube use in microlaryngeal surgery cases

Aim: To evaluate the feasibility and safety of the Tritube™ tube and Evone® ventilator and compare patients intubated using Tritube™ and ventilated with flow-controlled ventilation (FCV) using Evone® (TT–FCV group) to those intubated using a traditional microlaryngeal intubation tube and ventilated with volume-controlled ventilation (MLT-VCV group) in terms of perioperative parameters and outcomes during microlaryngeal surgery (MLS). &#x0D; Material and Method: A prospective observational design was conducted. This study was carried out in 6 (six) months between February 2022 and September 2022. After receiving their informed consent, 18 patients were randomly assigned to two groups. Patients older than 18 years, who were scheduled for elective MLS were included in the study. The closed opaque envelope method was used for randomization. The same standard anesthesia protocol was applied to all patients. The patients’ demographic parameters, American Society of Anesthesiology physical status (ASA), Mallampati and Cormack-Lehane scores, duration of ventilation, duration of surgery, hemodynamic parameters, ventilation parameters, and complications were recorded. &#x0D; Results: Twenty-one patients recruited for the study. Three of them regretted to participate to study. At the end 18 patients were analyzed. The mean age of population was 53(43-62). When the intraoperative respiratory and hemodynamic parameters of the patients were compared between the two groups, the regional cerebral oxygen saturation (rScO2) (p=0.020), tidal volume (p=0.005), compliance of the respiratory system (p=0.001), and post-extubation rScO2 (p=0.001) values were statistically significantly higher in the TT-FVC group compared to the MLT-VCV group. Right rScO2 (p=0.038), left rScO2 (p=0.047), and time to extubation (p=0.021) were statistically significantly lower in the TT-FVC group compared to the MLT-VCV group.&#x0D; Conclusion: According to the findings we obtained, utilizing Tritube™ and Evone® during MLS surgeries appears to be effective in terms of achieving safe airway management.

Tracheal intubation is not difficult with flexible bronchoscopy guidance

We aimed to evaluate the efficacy and safety of flexible bronchoscopy-guided tracheal intubation during difficult airways. We retrospectively evaluated the hospital records of intubated patients with the assistance of a flexible bronchoscope during 5 years-period, (between January 2015 to 2020). All patients were intubated under general anesthesia. A total of 67 patients were enrolled in the study. The majority of the patients were male (n=42, 62.7%). The mean age was 55.5±15.3 years. Mallampati classification was revealed frequently in class IV in 76.1% of cases. Only one patient with class II is evaluated as having a difficult airway because of obesity. The most frequent 3 indications for endotracheal tube (ETT) insertion (intubation) with the help of a bronchoscope were limitation of the mouth opening (40.3%), obesity (20.9%), and cervical-vertebrate fracture (11.9%). The intubation route was preferred as the oral way in 53 patients and the nasal way in 14 patients. The mean duration for ETT intubation via bronchoscopy guidance was 3.38 minutes. There was no severe complication other than transient oxygen desaturation (SaO2) below 90% (n=8, 11.9%) and epistaxis (n=2, 3%) in the complication records of all patients. Intubation with the help of a flexible bronchoscope is an effective, practical, and safe method in patients with a difficult airway.

Comparison of the angle deviation of the nose line to the mentum and Mallampati test in predicting the difficult airway before anesthesia.

A high percentage of dangerous events in anesthesia occur due to airway problems, and proper airway management is always one of the key points during anesthesia. Airway management in critically ill patients is one of the most stressful situations for primary care physicians and even for anesthesiologists. The aim of this study was to evaluate the anatomical features of patients' airways, including the angle of deviation of the nasal line from the nasal to the mentum (NMLD), and perform a Mallampati test. This cross-sectional study was performed on all patients admitted to Shohada Hospital in Tabriz, Iran, who were candidates for elective surgery for 1 year and 6 months, and underwent endotracheal intubation. Based on laryngeal observation, patients were classified into four groups. Then, all data related to individuals including type of surgery, age, sex, weight, height, body mass index (BMI), and nasal mentum line deviation (NMLD) were recorded. Then, all the collected data were analyzed using SPSS software version 19. A total of 85 patients from 17 to 67 years with a mean age of 37.64 ± 12.89 were studied. There was a statistically significant relationship between laryngoscopy difficulty and Mallampati score (P = 0.001). The findings showed a statistically significant relationship between laryngoscopy difficulty and the mean NMLD (P = 0.01). A Mallampati of 85% indicates laryngoscopy difficulty. Also, NMLD can predict laryngoscopy difficulty by up to 66%. The present study demonstrated that both the Mallampati score variable and NMLD are related to the difficult airway problem. Furthermore, the Mallampati score has a higher predictive value for difficult intubation than the NMLD.

ASSESSMENT OF STANDARD ANTHROPOMETRIC AIRWAY CHARACTERISTICS RELEVANT FOR AIRWAY MANAGEMENT OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME DURING SLEEP BREATHING DISORDER SURGERY: A RETROSPECTIVE, SINGLE CENTER STUDY.

The aim of this study was to explore standard anthropometric airway characteristics of patients with obstructive sleep apnea syndrome (OSAS) and determine the incidence and risk factors for difficult airway management. Final analysis included 91 patients with polysomnography-verified diagnosis of OSAS who underwent sleep breathing disorder surgery under general anesthesia with direct laryngoscopy oroendotracheal intubation. The incidence of difficult manual mask ventilation during anesthesia induction, difficult intubation and immediate postextubation respiratory complications was 17.6%, 7.7% and 7.7%, respectively. Compared to patients without difficult manual mask ventilation, the group of OSAS patients with difficult manual mask ventilation had a higher rate of body mass index (BMI) ≥25 kgm-2 (p=0.010), Mallampati score ≥3 (p=0.024) and Cormack-Lehane score ≥3 (p=0.002). The OSAS patients with difficult intubation had more Cormack-Lehane score ≥3 (p=0.002) in comparison to those without difficult intubation. Our study demonstrated that manual mask ventilation during anesthesia induction was the most troublesome airway management task in OSAS patients during sleep breathing disorder surgery. Cormack-Lehane score was a relevant determinator of difficult mask ventilation and difficult intubation, while Mallampati score and BMI were relevant determinators only for difficult manual mask ventilation.

Preoperative evaluation characteristics of bimaxillary surgery patients: A retrospective study in which prominent findings were evaluated with the literature review

In this study, we aimed to share our experience in preoperative anaesthesia evaluation for patients undergoing bimaxillary surgery in our hospital and review the relevant literature. We retrospectively evaluated 139 patients with ASA (American Society of Anesthesiology) physical status 1 and 2 who underwent bimaxillary surgery. Data were collected on demographic characteristics, ASA physical status, mallampati scores, systemic diseases, allergy history, consultation request status, consulted departments, smoking, alcohol or drug use, and previous exposure to general anaesthesia. The preoperative evaluation of bimaxillary surgery patients revealed several notable findings, including a relatively high rate of cardiovascular problems (48% rate among those with additional systemic disease), the need for otolaryngology (ENT) consultation being the most frequent (44% rate among all consultations), and a relatively high rate of active smoking (23.7%). Our findings suggest that the bimaxillary surgery patient group should be carefully evaluated, particularly regarding cardiovascular disease and difficult airway management

Accuracy of airway ultrasound parameters to predict difficult airway using the LEMON criteria as a reference: A cross-sectional diagnostic accuracy study.

Ultrasound (US) airway indexes were frequently compared with other scoring systems such as Mallampati score and Cormack - Lehane classification system, but to the best of our knowledge never with LEMON. Here, in this study, we evaluated the accuracy of some recommended airway US parameters in terms of screening difficult airway using the LEMON criteria as a reference. This was a cross-sectional diagnostic accuracy study in which people with at least 18 years old coming to the emergency departments for any reason who had consent for participation, were enrolled with the simple random sampling method. Hyo-mental distance (HMD), skin to epiglottis distance (EP), and peri-epiglottic space to epiglottis to vocal cord ratio (PEP/E. VC) were the US indexes that were calculated in all participants. Using a preprepared checklist, measured US parameters were recorded. For each participant, the LEMON score variables were also assessed and recorded, and the cutoff point for considering as a difficult airway case, based on LEMON score, was 2. Demographic characteristics of the participants were also registered. A total of 299 cases with a mean age of 41.1 years (95% confidence interval [CI]: 39.3-42.9), were participated. Based on LEMON score ≥2, 20 participants (6.7%) were categorized in difficult airway group. Comparison of the PEP/E. VC (P = 0.007) and EP distance (P = 0.049) of the participants based on LEMON score showed a statistically significant difference; but comparison of the means of HMD in the two groups was not statistically significant (P = 0.144). The median of EP of the participants was 7.70 mm (interquartile range [IQR]: 6.70-9.40). The best cutoff point of EP distance for evaluating a difficult airway was 12.27 mm and more with the sensitivity of 35% and the specificity of 86.96% (accuracy = 0.614; 95% CI: 0.492-0.736). The median of PEP/E. VC was 1.01(IQR: 0.79-1.23). The best cutoff point of PEP/E. VC for evaluating a difficult airway was 0.88 and less with the sensitivity of 70% and the specificity of 67.38% (accuracy = 0.701; 95% CI: 0.583-0.818). As per our results, PEP/E. VC and EP distance measured with sonography can be used in distinguishing the difficult airway, using the LEMON criteria as the reference. However, further studies are needed to use PEP/E. VC and EP distance as a part of reliable indexes.

Predicting Difficult Laryngoscopy by Ultrasound Quantification of Anterior Neck Soft Tissue Thickness-A Prospective Observational Study

Introduction: Difficult airway can possess a challenge to intubation and deciding role in morbidity and mortality. Hence, at these times Ultrasonography (USG) can play a vital role in the prediction of a difficult airway. Aim: To determine if USG measurement of anterior neck soft tissue thickness at the hyoid bone, and anterior commissure levels can be used to predict difficult laryngoscopy. Materials and Methods: The prospective observational study was carried out from January 2021-January 2022. There were 50 patients, aged 20-60 years, and scheduled to undergo general anaesthesia. Correlation analysis between roles of screening tests like Mallampati scoring (MMP), Cormack Lehane (CL) grade Neck Circumference (NC), Thyromental Distance (TMD) and USG measurements was done for predicting difficult laryngoscopy. Portable USG machine with a linear frequency probe, measuring tape and laryngoscope blade was required. The data was analysed using Statistical Package for Social Sciences (SPSS) version 22. Results: The incidence of difficult laryngoscopy was 18% and the mean age of the study participants in the easy group was 44.26 years and in the difficult group it was 45.13 years. The USG measurements were significant (p-value=0.01) in determining difficult intubation, which shows greater validity to predict difficult laryngoscopy. Hence, USG measurement along with bedside screening test aids in better identification and assessment of difficult airway. Conclusion: Anterior neck soft tissue thickness measured by USG at the hyoid bone, and anterior commissure levels combined with the screening tests and risk factors might increase the ability to predict difficult airways.

Factors predicting difficulty in insertion of real-time-three-dimensional transesophageal echocardiography probe in adult patients undergoing cardiac surgery.

Transesophageal echocardiography (TEE) probe insertion may be associated with many complications. Demographic factors and airway conditions such as high Mallampati scores (MMC) and Cormack-Lehane grades (MCLG) are likely to have an impact on its ease of insertion. The primary aim of this study was to identify the predictive factors for difficult real-time-three-dimensional TEE probe insertion. A total of 153 adult patients undergoing cardiac surgery were prospectively evaluated. The upper airway manipulations required for TEE probe placement were jaw thrust, reverse Sellick's maneuver, and laryngoscopy. All the patients who required airway manipulations were grouped under difficult TEE probe placement group. We evaluated the patients' predictive factors such as demographic characteristics and factors related to difficult intubation. Out of 153 patients, 123 were males and 30 were females. Overall, 27.5% (n = 42) patients had difficulty in probe placement. About 31.7% (n = 39) males had difficulty in TEE probe placement against 13% (n = 4) females (P-value 0.045). Difficulty in TEE probe placement was found in 72.7% (n = 16) of obese patients (body mass index [BMI] > 30), compared to 18.6% (n = 17) in the patients with BMI less than 25 (P-value < 0.001). Probe insertion was significantly more difficult in the presence of MMC III and IV (50%, n = 18) compared to class I (19.2%, n = 10) (P-value 0.001) and MCLG III (73.3%, n = 22) compared to grade I (11.1%, n = 7) (P-value 0.001). Male gender, obesity, higher grades of MMC and MCLG were found to be the risk factors for difficult TEE probe placement in anesthetized patients.

Awake video laryngoscopy aided intubation as an alternative to awake fiberoptic intubation in a patient with difficult airway.

Dear Editor, We are reporting the airway management of a 75-year-old male patient diagnosed with recurrent basal cell carcinoma (BCC) nose who had undergone multiple resections and facial reconstructive surgeries. He was posted for excision of recurrent BCC. On examination, his mouth had a fish-mouth appearance with restricted opening of approximately 4 cm. He had no nose, was edentulous with restricted tongue protrusion, and had a Mallampati score of 4. The patient had no other comorbidities and the investigations were within normal limits. After 6 h of fasting, the patient was taken up for surgery. The anesthetic plan was awake intubation followed by induction of general anesthesia (GA) and controlled ventilation. Fiberoptic bronchoscope (FOB) was unavailable and mask ventilation was seemingly impossible due to deformed facial contours. So, we planned to perform an initial awake check laryngoscopy under topical anesthesia. Following intravenous glycopyrrolate 0.2 mg, topicalization of oral cavity was done with 10% lignocaine spray. Then awake check laryngoscopy was performed with C MAC videolaryngoscope using D blade and we were able to visualize the glottic opening. Transtracheal block was given with 4 mL of 4% lignocaine, and then, under videolaryngoscopic visualization, a soft gum elastic bougie was introduced into the trachea. A 7.0mm internal diameter flexometallic endotracheal tube (ETT) was then railroaded over the bougie [Figure 1]. After observing regular end-tidal carbon dioxide waveforms, the patient was induced with propofol, paralyzed with vecuronium, and ETT was fixed at 21 cm at the left angle of the mouth. Fentanyl was used as an analgesic and anesthesia was maintained with isoflurane in an air–oxygen mixture. The intraoperative period was uneventful and the patient was extubated when fully awake after reversing neuromuscular blockade.Figure 1: Patient after intubationThough awake fiberoptic intubation (AFOI) is considered the gold standard for securing the airway in difficult airway patients, it may not be available always. Awake check laryngoscopy is helpful to plan mode of induction and intubation in difficult airway patients. Induction of GA in such patients is considered safe only if glottis could be visualized during check laryngoscopy. If FOB was available, oral AFOI would have been the ideal technique for our patient. Securing airway in patients with anticipated difficult airway in the absence of FOB could be accomplished by use of intubating laryngeal mask airway[1]or I gel,[2,3]a few among the many techniques described. We preferred intubation over supraglottic airway devices as they are bulkier than ETT and in the presence of reduced mouth opening, it would have further limited the surgical access for excision of the tumor at the mouth. Recent research has shown that videolaryngoscopes provide similar success rates and faster intubation times when compared with FOB-aided intubations in awake patients having difficult airways.[4,5]Optimal topicalization of the oral cavity, oropharynx, and the structures near the glottis as well as proper counseling of the patient are important for a successful outcome of this technique. We conclude that awake videolaryngoscopy followed by the introduction of soft gum elastic bougie into the trachea and railroading ETT over it is a safe alternative to AFOI during unavailability of FOB, provided the patient has adequate mouth opening. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Modified mallampati score – Does it predict more than a difficult airway? A community-based study assessing the association between modified mallampati score and obstructive sleep apnea

Modified mallampati score – Does it predict more than a difficult airway? A community-based study assessing the association between modified mallampati score and obstructive sleep apnea

Predictors of Retitration in the Sleep Laboratory

Background: Obstructive sleep apnea syndrome (OSAS) is a serious public health problem that causes a significant economic burden worldwide. Apart from several treatment approaches, positive airway pressure (PAP) therapy remains the gold standard. Performing an optimal manual titration study to explore the beneficial and comfortable pressure for patients is essential, but the process is troublous sometimes, requiring multiple attempts. The objective of this study was to present our single-center experience regarding PAP titration studies in OSAS and identify the clinical and laboratory parameters that might predict repeat titration. Materials and Methods: Medical charts of 248 patients with OSAS who were eligible for PAP therapy were retrospectively reviewed. Age, sex, body mass index, modified Mallampati scores, presence of positive Muller maneuvers, and polysomnographic parameters yielded from diagnostic studies were recorded and compared between patients with single versus repeat titrations. Results: The mean age, the proportion of males, and the rate of patients with positive Muller maneuvers were significantly increased in the retitration group (P = 0.015, P = 0.022, and P = 0.001, respectively). Multivariate regression analysis revealed that age and positive Muller maneuvers were independent associates of repeat titration (P = 0.036 and P = 0.005, respectively). Conclusion: Our results suggest that both aging and the presence of a positive Muller maneuver may predict a troublous titration study, raising the need for recurrent attempts. The final common pathway could contribute to a vulnerable and more collapsible airway during sleep. Recognizing the potential need for retitration at the beginning is favorable regarding adjustment of the laboratory conditions and increases the patients' adherence during the management course. The results also confirm the capability of manual titration in terms of exploring proper PAP pressures in the majority of patients with OSAS.

Towards a sensitive awake craniotomy: assessment of electrical mapping thresholds

Background. Awake surgery is currently a safe and reliable alternative for identifying and preserving functional areas. However, this protocol has evolved over time to minimize the occurrence of electrical stimulation-induced seizures and postoperative deficits. Objective. The aim of this study is to highlight both internal and external factors influencing the language and sensorimotor thresholds of electrical stimulation mapping (ESM) during gliomas awake surgery. Material and methods. From October 2016 to April 2022, we performed a retrospective study on 74 patients underwent awake craniotomy of gliomas in two series based on ESM: group 1 and group 2. Preoperatively and three months after surgery, general performance and neurological deficits were assessed according to the type, location, and side of the tumor in correlation with ASA, BMI, Mallampati and KPS indexes. Results. The outcome shows that the median patient age was 49 years old in a range of [13-70], functional mapping was performed in language areas for 96% of patients and motor functions for 54%. In addition, 55.5% of the patients had HGG, 40.5% had LGG, and 4% had AVMs. Most lesions were in the temporal area (40.5%), followed by the frontal area (31%), 24.5% for insular area, 4% for the parietal area, and 85% of patients had left-sided lesions. The overall rate of intraoperative complications fell from 16.2% in group 2 to 1.35% in group 1. Conclusions. Under the ESM threshold of group 1, a high-quality of awake surgery can be used with optimally low complications and failure rates regardless of BMI, ASA rating, Mallampati and KPS scores or smoking status.

OBEZ HASTALAR İÇİN GÜNÜBİRLİK ANESTEZİ UYGULAMALARI

Standard operating room conditions may not be provided in areas where ambulatory anesthesia is applied. For this reason, the infrastructure of the center should be taken into account when evaluating obese patients. Obesity is not an independent risk factor. Accompanying comorbidities are decisive in the development of perioperative complications. Obese patients should be evaluated for cardiac, pulmonary, endocrine, and OSAS. Particular attention should be paid when evaluating morbidly obese (BMI&gt; 40 kg / m2) patients. Comorbidities, not BMI alone, should be decisive in terms of suitability for outpatient surgery. Super morbid obese patients with BMI &gt; 50 kg / m2 can be taken to selected ambulatory surgery if there is no accompanying comorbidity. No relationship was found between BMI and difficult airway. However, it was stated that difficult mask ventilation and intubation were found in patients with a high mallampati score and neck circumference &gt;50 cm. Therefore, it may be helpful to look at the neck circumference of obese patients preoperatively. The drugs to be used should be adjusted according to the ideal body weight and used by titration. It is recommended to use wakefulness (BIS) monitoring methods when adjusting the anesthetic dose for obese patients. Non-opioid analgesia methods should be preferred. Opioids should be preferred as rescue analgesics. If possible, regional anesthesia and analgesia methods should be applied. Anatomical difficulties should be considered in regional anesthesia and analgesia applications. Hospitalization should be considered in surgeries longer than three hours. In surgeries longer than 6 hours, patients should be hospitalized.

The Relationship Between Mallampati Score And Obesity With the Risk of OSAHS in Down Syndrome Children

Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS) has commonly occured in Down syndrome children caused by the abnormalities in upper respiratory tract anatomy and obesity. This study aims to identify the correlation between Mallampati score and obesity and the risk of OSAHS in Down syndrome children. This was an analytical descriptive cross-sectional study. This study was conducted in children with Down syndrome from September until November 2017. All parents filled the Indonesian Pediatric Sleep Questionnaire (PSQ), then all of the children were examined for Mallampati score and BMI. The correlation was analyzed by the Pearson Chi-Square model. Thirty-six subjects were included in this study. The number of male subjects were slightly more (61.1%), the mean age of the subjects was 8.42±4,449 years, with 52.8% (19 subjects) having OSAHS. There were 23 subjects (63.9%) who had Mallampati scores of 3 and 4, with 13 subjects (36.1%) were obese. This study concluded a statistically significant correlation between Mallampati score and obesity and the risk of OSAHS in Down syndrome children (p-value 0.001 and 0.029). Mallampati score and obesity had a significant correlation with the risk of OSAHS in Down syndrome children.

EVALUATION OF AIRWAY INDICES FOR PREDICTING DIFFICULTY IN ENDOTRACHEAL INTUBATION IN PATIENTS WITH DIABETES MELLITUS

Background:The need to predict potentially difcult tracheal intubation has received more importance but with limited success. The present study was conducted to assess various airway evaluation indices used to predict difcult airway in Indian patients with diabetes mellitus. Methods: This prospective, observational study was carried out in 85 patients at a tertiary care hospital in Western India. All patients underwent thorough airway assessment using modied Mallampati classication, mouth opening, upper lip bite test, thyromental distance, head extension, palm print, prayer sign and body mass index. Preoperative data of the various airway indices were co-related with difcult intubation to evaluate the sensitivity, specicity, positive predictive value and negative predictive value of each test. Results: Overall, the best indicator to predict difcult intubation in patients with diabetes was the palm print (58.7% sensitive; 94.9% specic; 75.3% accurate) followed by Mallampati score (50% sensitive; 94.9% specic; 70.6% accurate) and prayer sign (54.3% sensitive; 89.7% specic; 70.6% accurate). There was a signicant association between prediction of difcult intubation and occurrence of complications during intubation in patients with diabetes. Conclusion: Even though all airway indices have their place in an anesthesiologists' armamentarium, the palm print is an ideal predictor of difcult intubation in patients with diabetes, followed by the Mallampati score and the prayer sign.

To Compare the Intravenous Bolus Dose of Propofol With an Equipotent Dose of Intravenous Thiopentone for the Facilitation of Laryngeal Mask Airway Insertion.

Objectives Insertion of laryngeal mask airway has been facilitated by using a variety of induction agents and their combinations with minimal side effects. The current prospective study is a randomized, double-blind study conducted using induction agents, namely, propofol and its equipotent dose of thiopentone, for laryngeal mask airway insertion, and to compare their side effects in patients undergoing minor surgeries requiring general anaesthesia. Methods This prospective study was carried out at the Anaesthesiology and Critical Care Department of Gauhati Medical College and Hospital (GMCH), Assam, India. The randomized, double-blinded study comprised 80 patients aged 18 to 60 years undergoing minor surgeries (≤45 minutes) under general anaesthesia fitting into the American Society of Anesthesiologists (ASA) physical status I and II and Mallampati score (MPS) 1 and 2. The participants were randomly divided into two groups in a 1:1 ratio. Group A (n= 40) received propofol(2.5 mg/kg), while group B (n = 40) received thiopentone(5 mg/kg) injections for induction of anaesthesia. Pre-medication with midazolam (0.04 mg/kg)injectionand fentanyl (1.5 mcg/kg) injectionwas provided to patients in both groups. Post-laryngeal mask airway insertion, parameters like conditions for insertion, time taken for laryngeal mask airway insertion, overall response,and haemodynamic parameters were recorded. The data analysis was executed using equivalence tests considering a two-sided p< 0.05 as significant. Results Group Ahad a higher and statistically significant ease of insertion (p = 0.029). The mean insertion time was notably different between the two groups (p < 0.001). The difference in the overall response to insertion showed no statistical significance in the two groups. Statistically, a significant difference was found in falls in heart rate and various blood pressure levels between the groups (p < 0.001). Conclusion Propofol at a rate of 2.5 mg/kg was found to be superior to thiopentone at a rate of 5 mg/kg as far as suppression of upper airway reflexes in laryngeal mask airway insertion.

Difficult airway management in an emergency in Nepal

Introduction: Health care provider often face challenges in managing airway in-patients in emergency department having respiratory compromise. Here in this review, we have discussed advances in management of difficult airway in emergency setting in Nepal.&#x0D; Method: Articles available n google scholar with key word “ airway management’’, “difficult airway” , “ emergency” , “failed intubation”, “ Nepal” were retrieved. Amongst which 14 articles were retrieved for the discussion.&#x0D; Result: MMT was better for predicting difficult laryngoscopy when compared to measurement of sternomental, thyromental and inter-incisor distances and grading of mandibular protrusion. Similarly when comparing upper lip bite test to MMT, ULBT has better sensitivity and specificity. laryngoscopic view with 5 cm of head elevation had a better visualization.&#x0D; Conclusion: The available evidence recommend using upper lip bite test in emergency setting with comparison to modified / mallampati classification. Different tests can be used in accordance to urgency of intervention. Similarly, head elevation of 5 cm can be routinely practiced for better visualization during laryngoscopy.

Measurement of Neck Circumference, Tongue thickness and Skin to Epiglottis Distance as Predictors of Difficult Intubation: A Prospective Study

Airway Assessment is essential in pre anesthetic assessment. Anticipating and preparing for difficulty in airway management is crucial to avoid airway catastrophes. Routine pre operative airway examination usually includes mouth opening and dentition, Mallampati classification, thyromental distance and neck movements. Neck circumference is a quick bedside test to determine difficult laryngoscopy. Increased tongue thickness and skin to epiglottis distance affects performance of laryngoscopy and tracheal intubation increasing the risk of difficult airway. Presently there is a search for non-invasive and accurate tools to overcome limitations of clinical airway assessment tests. Ultrasonography has been evolving as a useful device for airway assessment especially soft tissue structures in anterior surface of neck. Here we studied the measurement of neck circumference and ultrasound measurement of tonguethickness and skin to epiglottis distance as predictors for difficult intubation. The Aim of the study is to predict difficulty in intubation by measuring neck circumference, thickness of tongue and thickness of skin to epiglottis. Prospective observational study, 120 patients posted for surgery under general anesthesia, Department of anesthesia, Meenakshi medical college, Kanchipuram. After institutional Human ethical committee clearance, 120 Patients were screened during preoperative assessment for undergoing procedures under general anaesthesia. Neck circumference and other airway parameters were measured with measuring tape and distance between Skin to epiglottis and tongue thickness were measured with ultrasound linear probe. Patients were grouped into Group E( Easy Intubation) whose Cormack-lehane grade was 1 and 2 and Group D ( Difficult intubation) whose Cormack-lehane grade was 3 and 4. SPSS version 16 was used for statistical analysis. There was no statistical significance seen between age, sex, height among easy and difficult intubation but significance was seen with weight (p &lt;0.05), Thyromental distance(p&lt;0.05) and Sterno-mental distance(p&lt;0.05). High significance was seen in Distance between skin to epiglottis distance(p&lt;0.001), Tongue thickness(p&lt;0.001) and Neck Circumference(p&lt;0.001) in difficult intubation cases. Neck circumference and ultrasonographic measurement of tongue thickness and skin to epiglottis can avoid unanticipated difficult intubation.