Modified Mallampati and Upper Lip Bite Test; A Comparative Analysis for Reliability of the Tests at Northwest General Hospital and Research Centre
Abstract
ABSTRACT
INTRODUCTION: Intubation is ascribed as difficult intubation if it requires more attempts or it takes more than 30 secs during laryngoscopy. The most serious complications faced by an anesthetist are difficult airway. Therefore, anesthetists must ensure a suitable airway for proper ventilation.
OBJECTIVE: To compare the reliability of the two most widely used preoperative tests for prediction of difficult intubation, Modified Mallampati test (MMT), and Upper Lip Bite Test (ULBT).
METHODOLOGY: After taking approval from the institutional ethical committee, total 360 patients divided into two groups, having age between 18-60 years, presented for general anesthesia undergoing elective surgeries requiring tracheal intubation having ASA grading 1, 2, 3 and 4 were included. Both the tests were performed on the patients preoperatively and difficulty in intubation was also assessed and recorded during intubation. Statistical analysis was performed and true and false positivity and negativity were assessed and compared.
RESULTS: In MMT, we found 18 (10%) in which 9 (50.0% of the difficult cases) were attributed to MMT class III which is 27.3% of total 33 MMT class III and 3 cases (16.7% of total difficult cases) with MMT class IV which is 75% of total 4 MMT class IV, both of which are true positive. Among the ULBT these 16 (8.9%) difficult cases ULBT class I has 1 (6.3%) case that is 1.6% of total 63 ULBT class I and ULBT class II had 9 (56.3% out of 16) cases that is 8.7% of total 104 ULBT class III, both of which are false negative. 7 (4.3%) out of 164 easy cases in ULBT class III are false positive, which accounts for 46.2 % among 13 ULBT class III.
CONCLUSION: This study showed that most of the cases were predicted incorrectly. However, when compared, the Modified Mallampati Test showed less contradiction between predictions and results than Upper Lip Bite Test, so it can be considered more reliable for prediction of difficult intubation.
KEY WORDS: Compare, Reliability, Preoperative tests, Prediction of difficult intubation, Modified Mallampati test (MMT), Upper Lip Bite Test (ULBT)
References
Langenstein H, Cunitz G. Difficult intubation in adults. Der Anaesthesist. 1996;45(4):372-83.
Paix A, Williamson J, Runciman W. Crisis management during anaesthesia: difficult intubation. BMJ Quality & Safety. 2005;14(3):e5-e.
Hegde HV, Prasad KC, Bhat MT, Hegde JS, Cb SM, Yaliwal VG, et al. Airway difficulty in Mallampati ‘class zero’patients: a prospective double-blind observational study. European Journal of Anaesthesiology (EJA). 2012;29(7):338-42.
Aitkenhead. The Practical Conduct Of Anesthesia. 6 ed2013.
Kala GP, Kumar SA, Sandeep G, Khawar A, Mazar I. Comparison of Upper Lip Bite Test with Modified Mallampati Classification for Prediction of Difficult Endotracheal Intubation. Med Phoenix. 2018;4(1):21-6.
Ali MA, Qamar-ul-Hoda M, Samad K. Comparison of upper lip bite test with Mallampati test in the prediction of difficult intubation at a tertiary care hospital of Pakistan. Journal of Pakistan Medical Association. 2012;62(10):1012.
Wong S, Hung C. Prevalence and prediction of difficult intubation in Chinese women. Anaesthesia and intensive care. 1999;27(1):49-52.
Siddiqi R, Kazi WA. Predicting difficult intubation--a comparison between Mallampati classification and Wilson risk-sum. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. 2005;15(5):253-6.
Türkan S, Ates Y, Cuhruk H, Tekdemir I. Should we reevaluate the variables for predicting the difficult airway in anesthesiology? Anesthesia & Analgesia. 2002;94(5):1340-4.
Hung O, Mills J. Predictions and clinical decisions: a fine balance. Canadian Journal of Anesthesia. 2000;47(8):721.
Wilson M, Spiegelhalter D, Robertson J, Lesser P. Predicting difficult intubation. BJA: British Journal of Anaesthesia. 1988;61(2):211-6.
Biebuyck JF, Benumof JL. Management of the difficult adult airway with special emphasis on awake tracheal intubation. Anesthesiology: The Journal of the American Society of Anesthesiologists. 1991;75(6):1087-110.
Jimson CT, Rimm EB, Hussain A. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study. Anesthesia & analgesia. 1995;81(2):254-8.
SHIGA T. Predicting difficult intubation in apparently normal patients. A meta analysis of bedside screening test performance. Anesthesiology. 2006;105:885-91.
Karci A, Karagöz S, Girgin P, Bozdogan D. Comparison of modified Mallampati classification, upper lip bite test and neck circumference in prediction of difficult intubation: 19AP5-5. European Journal of Anaesthesiology (EJA). 2011;28:236.
Eberhart LH, Arndt C, Cierpka T, Schwanekamp J, Wulf H, Putzke C. The reliability and validity of the upper lip bite test compared with the Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation. Anesthesia & Analgesia. 2005;101(1):284-9.
Khan ZH, Kashfi A, Ebrahimkhani E. 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. Anesthesia & Analgesia. 2003;96(2):595-9.
Khan ZH, Maleki A, Makarem J, Mohammadi M, Khan RH, Zandieh A. A comparison of the upper lip bite test with hyomental/thyrosternal distances and mandible length in predicting difficulty in intubation: A prospective study. Indian journal of anaesthesia. 2011;55(1):43.
Brodsky JB, Lemmens HJ, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesthesia & Analgesia. 2002;94(3):732-6.
Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, et al. A clinical sign to predict difficult tracheal intubation; a prospective study. Canadian Anaesthetists’ Society Journal. 1985;32(4):429-34.
