Prediction of Difficult Airway Among Pediatric and Adult Patients Scheduled for Ophthalmological Surgeries under General Anesthesia

Authors

  • Sana Abbas Department of Anaesthetisa National University of Medical Sciences Rawalpindi, Pakistan
  • Aisha Rafique Department of Ophthalmology National University of Medical Sciences Rawalpindi, Pakistan.
  • Usman Saqib Department of Anaesthetisa National University of Medical Sciences Rawalpindi, Pakistan.

Keywords:

Airway, Cormack-Lehane Grading, Laryngoscopy, Mallampati score, Prevalence

Abstract

Objective: To evaluate the sensitivity and specificity of bedside tests for prediction of difficult airway scheduled for ophthalmological surgeries under general anesthesia.
Methods: This prospective study was carried out at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from March 2020 to October 2020. All pediatric and adult patients with American society of anesthesiologist grade I to IV undergoing elective ophthalmological surgeries under general anesthesia were consecutively enrolled. Mallampati grading, sternomental, thyromental distance, and mouth opening used as the predictors tools whereas Cormack and Lehane (CL) classification validated with on table laryngoscopy. Grade I and II were assigned as easy laryngoscopy whereas grade III and IV were declared as difficult intubation.
Results: Of 232 patients, difficult intubation was observed in 36 (15.5%). Sensitivity and specificity of thyromental distance was 80.5% and 99.4% respectively. Whereas sensitivity of mouth opening was 66.6% and specificity was 99.4%. In case of sternomental distance, sensitivity and specificity corresponded to 61.6% and 100% respectively. The sensitivity and specificity of Modified Mallampati Grading was 97.2% and 96.4% respectively. The relationship between CL grading and MMC showed that all the patients with CL grade I had Malampati grade I, i.e., 28 (100%), while all patients with CL grade IV had Malampati grade IV, i.e., 7 (100%).
Conclusion: Bedside tests prove to be useful parameters for prediction of difficult airway at pre-anesthesia assessment among which Mallampati test is most sensitive and specific, subsequently ensuring availability of difficult intubation equipment, which is a focus of concern in third world countries.

 

Downloads

Download data is not yet available.

References

Badheka JP, Doshi PM, Vyas AM, Kacha NJ, Parmar VS. Comparison of upper lip bite test and ratio of height to

thyromental distance with other airway assessment tests for predicting difficult endotracheal intubation. Indian J Crit Care Med 2016; 20:3-8. doi: 10.4103/0972-5229.173678.

Panjiar P, Kochhar A, Bhat KM, Bhat MA. Comparison of thyromental height test with ratio of height to

thyromental distance, thyromental distance, and modified Mallampati test in predicting difficult laryngoscopy: A prospective study. J Anaesthesiol Clin Pharmacol 2019; 35:390-5. doi: 10.4103/joacp.JOACP_276_18.

Vidhya S, Sharma B, Swain BP, Singh UK. Comparison of sensitivity, specificity, and accuracy of Wilson's score

and intubation prediction score for prediction of difficult airway in an eastern Indian population-A prospective single-blind study. J Family Med Prim Care 2020; 9:1436-41. doi: 10.4103/jfmpc.jfmpc_1068_19.

Nasr-Esfahani M, Honarmand A, Safavi SM, Tafti MA. How to predict difficult tracheal intubation: The application of acromio-axillo-suprasternal notch index. Adv Biomed Res 2020; 9:19. doi: 10.4103/abr.abr_228_19.

Nurullah M, Alam MS, Hossen M, Shahnawaz M. Prediction of difficult airway by thyromental height test-a comparison with modified mallampati test. Bangla J Med Sci 2018; 17:455-61. doi:org/10.3329/bjms.v17i3.37014

Aktas S, Atalay YO, Tugrul M. Predictive value of bedside tests for difficult intubations. Eur Rev Med Pharmacol Sci 2015; 19:1595-9Shirgoska B, Netkovski J. Predicting difficult airway in apparently normal adult and pediatric patients. Prilozi 2013; 34:155-9.

Zhou C, Chung F, Wong DT. Clinical assessment for the identification of the potentially difficult airway. Perioper Care Oper Room Manag 2017; 9:16-9.

Zahedi H, OstadAlipour AB, Jamshidi M, Nikoseresht M, Malaki A, Noori M. Evaluation of upper lip bite test (ULBT) for prediction of difficult intubations. Iran J Anesthesiol Crit Care 2016; 38:51-60.

Adamus M, Fritscherova S, Hrabalek L, Gabrhelik T, Zapletalova J, Janout V. Mallampati test as a predictor

of laryngoscopic view. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2010; 154339-44.

Faramarzi E, Soleimanpour H, Khan ZH, Mahmoodpoor A, Sanaie S. Upper lip bite test for prediction of difficult airway: a systematic review. Pak J Med Sci 2018; 34:1019-25. doi: 10.12669/pjms.344.15364

Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits AM, Arrich J, et al. Airway physical examination tests for

detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst Rev 2018; 5: Cd008874. doi: 10.1002/14651858.CD008874

Selvi O, Kahraman T, Senturk O, Tulgar S, Serifsoy E, Ozer Z. Evaluation of the reliability of preoperative

descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized

clinical study. J Clin Anesth 2017; 36:21-6. doi: 10.1016/j.jclinane.2016.08.006

Shah S. Prevalence and predition of difficult intubation in the Nepalese population. JSAN 2015; 2:17-20.

doi.org/10.3126/jsan.v2i1.13552

Khan ZH, Mohammadi M, Rasouli MR, Farrokhnia F, Khan RH. The diagnostic value of the upper lip bite test

combined with sternomental distance, thyromental distance, and interincisor distance for prediction of easy laryngoscopy and intubation: a prospective study. Anesth Analg 2009; 109: 822-4. doi: 10.1213/ane.0b013e3181af7f0d.

Vilardell ME, Schmucker E, Andreu E, Villaverde I, Munar F, Montferrer N. Incidence of difficult airway in a

pediatric tertiary hospital. Eur J Anaesthesiol 2013; 30: 269.

Khatiwada S, Bhattarai B, Pokharel K, Acharya R. Prediction of difficult airway among patients requiring

endotracheal intubation in a tertiary care hospital in Eastern Nepal. JNMA J Nepal Med Assoc 2017; 56:314- 318

Cook TM, MacDougall-Davis SR. Complications and failure of airway management. Br J Anaesth 2012;

:i68-i85. doi: 10.1093/bja/aes393.

Auroy Y, Benhamou D, Pequignot F, Bovet M, Jougla E, Lienhart A. Mortality related to anaesthesia in France:

analysis of deaths related to airway complications. Anaesthesia 2009; 4:366-70. doi: 10.1111/j.1365-2044.2008.05792.x

Downloads

Published

2021-04-06 — Updated on 2022-01-13

Versions

How to Cite

Abbas, S., Rafique, A., & Saqib, U. (2022). Prediction of Difficult Airway Among Pediatric and Adult Patients Scheduled for Ophthalmological Surgeries under General Anesthesia. Journal of the Dow University of Health Sciences (JDUHS), 15(1), 4–9. Retrieved from https://jduhs.jduhs.duhs.edu.pk/index.php/jduhs/article/view/1072 (Original work published April 6, 2021)

Issue

Section

Original Articles