A COMPARATIVE STUDY OF MODIFIED MALLAMPATI CLASSIFICATION WITH NECK CIRCUMFERENCE ALONG WITH UPPER LIP BITE TEST IN MORBIDLY OBESE PATIENTS

Volume : VII, Issue : IV, April - 2018

Dr. Atul Dixit, Dr. Swati Sharma, Dr. Sadhana Sanwatsarkar, Dr. Sourabh Jain, Dr. Rajbhan Singh, Dr. Raghav Sain Gupta

INTRODUCTION Anaesthesia in morbidly obese patients can present many challenges. The overriding concern of most

anaesthesiologists is airway management, as obese patients have been thought to be at greater risk of difficult airway and/or difficult

intubation, when compared with the general population.

The term difficult airway has been defined by the American Society of Anaesthesiologists (ASA) taskforce as the clinical situation in

which a conventionally trained anaesthesiologist experiences problems with mask ventilation or tracheal intubation or both.

AIMS AND OBJECTIVES– To assess the positive predictive value,sensitivity and specificity of MMPC, NC along with ULBT and

compare it with Cormack Lehane grading intraoperatively.

MATERIALS AND METHODPreoperative

airway assessment of 200 patients posted for surgery under general anaesthesia was carried out to evaluate the

usefulness of multiple screening tests in predicting the ease or difficulty of laryngoscopy in obese patients undergoing laparoscopic

bariatric surgery. Modified Mallampati test grade III or IV, Upper Lip Bite test grade III, Neck Circumference >40cm were considered as

predictors of difficult laryngoscopy.

Laryngoscopy was considered difficult if the view on laryngoscopy was Cormack and Lehane grade III or IV. The results were evaluated

on the basis of sensitivity, specificity, positive and negative predictive value and accuracy of these tests.

RESULT– Group A (ULBT+MMPC) identified 65% of the patients with difficult intubation (sensitivity of 92.86 % & specificity of 33.3

%), whereas Group B (ULBT+NC) identified 75% of the patients with difficult airway (sensitivity 93.75% & specificity of 25%).

Pearson Correlation analysis was applied to know the correlation between the various tests and the Cormack Lehane Classification,

both the groups had p value of 0.001 , which was highly significant.

CONCLUSION– When multiple predictors are taken into consideration there was a considerable reduction in false negatives with

significant improvement in accuracy of test and hence prediction of difficult laryngoscopy was made easy. Application of

multiple predictors in combination can reduce the frequency of unanticipated difficulty and unnecessary interventions related to

over prediction of airway difficulty.