A comparison of Acromio–axillo–suprasternal notch index (a new test) with modified Mallampati classification for prediction of difficult airway in the Indian population: a prospective observational study.

DR. CHARU BAMBA; DR.POONAM GUPTA

Volume : IX, Issue : VIII, August - 2019

A comparison of Acromio–axillo–suprasternal notch index (a new test) with modified Mallampati classification for prediction of difficult airway in the Indian population: a prospective observational study.

Dr. Charu Bamba, Dr. Poonam Gupta

Abstract :

Background: Unanticipated difficult intubation or failed intubation during surgery under general anaesthesia may result in cardiac arrest or ain death. We designed a double–blind prospective study to evaluate and compare the efficacy of Acromio –Axillo –Suprasternal notch index (AASI) with most commonly used modified Mallampati test (MMT) as a predictor of difficult intubation. Methods: 407 adult patients in American society anaesthesiologist physical status (ASA) I and II, requiring tracheal intubation undergoing elective surgery were enrolled in this single blinded study. Preoperative airway assessment was carried out with AASI and MMT. Following general anaesthesia, direct visualization of the larynx was graded on Cormack–Lekane classification ( C–L) by an experienced anaesthesiologist.. C–L grade III and IV were considered as difficult visualization of larynx (DVL). Patient data and airway predictors were compared by Chi–square/Fishers exact test. and for quantitative variable statistical significance was determined by T–test/ Mann Whitney Test .The primary objective was to evaluate AASI as a predictor of DVL and the secondary objective was to compare AASI and MMT for DVL. Results: Difficult visualization of the larynx (DVL, Cormack – Lehane III & IV) was observed in 28 (6.8%) of patients. AASI with higher predictive values and low false values in comparison to MMT at cut off point ≥ 0.5 cms can detect DVL better . Conclusion: AASI (≥ 0.5 cms ) can be a useful and reliable predictor of DVL in routine anaesthesia practice.