Title: Comparative Study of Upper Lip Bite Test & Modified Mallampati Score in Predicting Difficult Intubation

Authors: Dr Saahir Boolaky, Dr P.S.Indurkar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.74

Abstract

Background: Good airway management defines an anesthesiologist .Link between unanticipated difficulty during endotracheal intubation with anaesthetic morbidity and mortality has been proved. Therefore it becomes necessary to predict difficult intubation as accurately as possible. Upper lip bite test is one proposed tests to predict difficult intubation.

Objectives: To compare sensitivity, specificity, positive predictive value and negative predictive value of ULBT and MMT to predict difficulty in endotracheal intubation.

Methods: A prospective study was carried on 124 patients, both sexes aged between 18 yrs to 60 yrs scheduled for elective surgeries under general anaesthesia fulfilling inclusion and exclusion criteria.

Patient airway was evaluated by MMT and ULBT preoperatively. Predictors of difficult endotracheal intubation were assigned to MMT class III and IV, ULBT class III. After premedication and induction laryngoscopy was performed in sniffing position. The glottic view was graded according to the Cormack and Lehane classification. Difficult intubation was assigned to Patients of Cormack Lehane class III / IV.

Results: Incidence of difficult intubation in our study was found to be 17.7% i.e. 22 out of 124) .ULBT was found to be more sensitive and had higher positive predictive value. But, specificity and negative predictive value of both the tests were comparable.

Conclusions: ULBT is a better predictor of difficult endotracheal intubation when compared to MMT and both the tests are better predictors of easy intubations than of difficult intubation.

Keywords: Difficult intubation, Modified Mallampati Test, Upper Lip Bite Test, Cormack Lehan.

References

  1. Braz LG, Braz DG, de Cruz DS, Fernandes LA, Módolo NSP, Braz JRC. Mortality in Anesthesia: A Systematic Review. Clinics (Sao Paulo, Brazil). 2009; 64 (10): 999 - 1006. Doi: 10. 1590 / S1807 - 59322009001000011.
  1. Crosby Et al. The unanticipated difficult airway with recommendations for management: Can J Anaesth. 1998;45:7: 757-776
  2. Posner KL, Caplan RA.; Hagherg CA, In, Benumof's Airway Management Principles and Practice; 2nd edition, Philadelphia: Mosby Elsevier; 2007, 1272-1282.
  3. Caplan RA, Posner KL, Ward RJ, Cheney FW: Adverse respiratory events in Analysis. Anaesthesiology 1990; 72: 828-833
  4. Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. 2005 Aug; 103(2):429-37.
  5. Milan Adamusa, Sarka Fritscherovaa, Lumir Hrabalekb , Tomas Gabrhelika, Jana Zapletalovac, Vladimir Janout, Mallampati test as a predictor of laryngoscopy view,154(4):339-43. DOI: 10.5507/bp.2010.051
  6. Wilson ME, Spiegelhalter D,Robertson JA,Lesser P.Predicting difficult intubation.BJA 1987;42:1115
  7. Khan ZH, Arash kashfi , Elham Ebrahimkhani: A comparison of the Upper Lip Bite Test (a simple New Technique) with Modified Mallampati classification in Predicting Difficulty in Endotracheal Intubation: A Prospective Blinded Study. Anesth Analg 2003; 96:595-9
  8. Murphy M, Hung O, Launcelott G, Law JA, Morris I. Predicting the difficult laryngoscopic intubation: are we on the right track? Can J Anaesth 2005;52:231–5
  9. Shah PJ, Dubey KP, Yadav JP. Predictive value of upper lip bite test and ratio of height to thyromental distance compared to other multivariate airway assessment tests for difficult laryngoscopy in apparently normal patients. J Anaesthesiol Clin Pharmacol 2013;29:191-5
  10. Muhammad Ashgar Ali, Comparison of upper lip bite test with Mallampati test in the prediction of difficult intubation at a tertiary care hospital of Pakistan, JPMA 62: 1012; 2012
  11. Balasubramanyam Vallem, Jamuna Thalisetty, Srikanth Challapalli, Nicolas Israel, Sowmya Gudise, Sowjanya Murthigari. Comparison of Upper Lip Bite Test with other Four Predictors for Predicting Difficulty in Intubation. Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 39, May 14; Page: 6811-6817, DOI: 10. 14260/jemds/2015/988
  12. Eberhart, Leopold H. J.; Arndt, Christian; Cierpka, Thomas; More The Reliability and Validity of the Upper Lip Bite Test Compared with the Mallampati Classification to Predict Difficult Laryngoscopy: Anesthesia & Analgesia. 101(1):284-289, July 2005.
  13. Naithani, Udita, et al, PREDICTING DIFFICULT INTUBATION IN SURGICAL PATIENTS SCHEDULED FOR GENERAL ANAESTHESIA: Journal of Evolution of Medical and Dental Sciences, 2013:Vol 2, Issue 14, April 8; Page 2270-2286
  14. Mohan K et al. Comparison of upper lip bite test with thyromental distance for predicting difficulty in endotracheal intubation: A prospective study: Asian Journal of Biomedical and Pharmaceutical Sciences; 3(22) 2013, 62-65
  15. Safavi, Mohammadreza, Azim Honarmand, and Narges Zare. "A comparison of the ratio of patient's height to thyromental distance with the modified Mallampati and the upper lip bite test in predicting difficult laryngoscopy." Saudi journal of anaesthesia 5.3 (2011): 258.
  16. Karci, A.; Karagöz, S.; Girgin, P.; Bozdoǧan, D. Comparison of modified Mallampati classification, upper lip bite test and neck circumference in prediction of difficult intubation: 19AP5‐5,June 2011 - Volume 28 - Issue - p 236
  17. Hester, Christopher Evan, et al. "A comparison of preoperative airway assessment techniques: the modified Mallampati and the upper lip bite test." AANA journal 75.3 (2007): 177.
  18. Badhe, Bhat, Ravindra R., S. Kumar Miashra, and A. S. "Comparison of upper lip bite test and modified Mallampati classification in predicting difficult intubation." Internet J Anesthesiol 13.1 (2007).
  19. Burkle CM, Walsh MT, Harrison BA, et al: Airway management after failure to intubate by direct laryngoscopy: Outcomes in a large teaching hospital. Can J Anaesth 2005; 52:634-640
  20. Bilgin H, Ozyurt G. Screening tests for predicting difficult laryngoscopy: A clinical assessment in Turkish patients. Anaesth Intensive Care 1998; 26:382-6.
  21. Kodali BS et al. Anesthesiology 2008; 108:357-62 British Journal of Anaesthesia 107 (5): 659–67 (2011) Advance Access publication 26 September 2011
  22. H. Lundstrøm, M. Vester-Andersen, A. M. Møller, S. Charuluxananan and J. Wetterslev, the Danish Anaesthesia Database, Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients, BJA 107 (5): 659–67 (2011)
  23. Mehta T, Jayaprakash J, Shah V. Diagnostic value of different screening tests in isolation or combination for predicting difficult intubation: A prospective study. Indian Journal of Anaesthesia. 2014; 58(6):754-757. doi:10.4103/0019-5049.147176.
  24. Rosenstock C, Gillesberg I, Gatke MR, Levin D, Kristensen MS, Rasmussen LS. Inter-observer agreement of tests used for prediction of difficult laryngoscopy/tracheal intubation. Acta Anaesthesiol Scand. 2005;49:1057–62
  25. Horton WA, Fahy L, Charters P: Disposition of cervical vertebrae, atlanto-axial joint, hyoid and mandible during X-ray laryngoscopy. British Journal of Anaesthesia 1989; 63:435-438.
  26. Oates JDL, Macleod AD, Oates PD, Pearsall FJ, Howie JC, Murray GD: Comparison of two methods for predicting difficult intubation British Journal of Anaesthesia 1991; 66:305-309.
  27. Karkouti K, Rose DK, Ferris LE, Wigglesworth DF, Meisamai-Fard T, Lee H. Inter-observer reliability of ten tests used for predicting difficult tracheal intubation. Can J Anaesth. 1996;43:554–9
  28. Chohedri AH, Tabari M. The upper lip bite test to predict difficult intubation. Prof Med J. 2005; 12:440–5.
  29. Frerk CM: Predicting difficult intubation. Anaesthesia1991; 46:1005-1008.
  30. Hilditch WG, Kopka A, Crawford JM, Asbury AJ. Interobserver reliability between a nurse and anaesthetist of tests used for predicting difficult tracheal intubation. Anaesthesia. 2004; 59:881–4. [Pub Med]
  31. Yentis SM. Predicting difficult intubation: Worthwhile exercise or pointless ritual? Anaesthesia. 2002; 57:105–9.
  32. Lee A, Fa LT, Karmakar MK. A systematic review (meta-analysis) of the accuracy of the Mallampati Tests to predict the difficult airway. Anest Analg.2006; 102(6):1867-78
  33. Honarmand A, Safavi M, Yaraghi A, Attari M, Khazaei M, Zamani M. Comparison of five methods in predicting difficult laryngoscopy: Neck circumference, neck circumference to thyromental distance ratio, the ratio of height to thyromental distance, upper lip bite test and Mallampati test. Adv Biomed Res 2015; 4:122. DOI: 10.4103/2277-9175.158033
  34. Srinivasa S, Vrinda Oza, Vasantha Kumar, Vandana Parmar and V.A. Chhaya, Assessment of difficult airway predictors for predicting difficult laryngoscopy and intubation, International Journal of Biomedical And Advance Research. ISSN: 2229-3809 (Online). Journal DOI: 10.7439/ijbar. CODEN: IJBABN. IJBAR (2014) 05 (07).

Corresponding Author

Dr P.S. Indurkar

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