Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section

Year 2017, Volume: 34 Issue: 5, 436 - 443, 01.09.2017

İlker Yıldırım Mehmet Turan İnal Dilek Memiş F. Nesrin Turan

Abstract

Background: Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. Aims: To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. Study Design: Cross-sectional study. Methods: Pregnant women (n=250) scheduled for caesarean section were analysed. The patients" ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. Results: No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05). The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively. We found a sensitivity and specificity of 93.75 and 95.30, respectively, for the combination of the upper limb bite test with the thyromental distance test. The sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test and interincisor distance test were found to be 46.15 and 100, respectively. For combination of all the tests, the sensitivity and specificity was 42.31 and 100, respectively. Conclusion: When all combinations are evaluated in the decision of difficult intubation, the combination of the upper limb bite test and thyromental distance test is superior to the use of other methods alone to predict difficult intubation in pregnant women.

Keywords

Caesarean section, difficult intubation, predictive tests

References

• 1. Hawkins JL, Chang J, Palmer SK, Gibbs CP, Callaghan WM. Anesthesiarelated maternal mortality in the United States: 1979-2002. Obstet Gynecol 2011;117:69-74.
• 2. Hawthorne L, Wilson R, Lyons G, Dresner MFailed intubation revisited: 17-yr experience in a teaching maternity unit. Br J Anaesth 1996;76:680-4.
• 3. Caplan RA, Posner KL, Ward RJ, Cheney FW. Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology 1990;72:828-33.
• 4. Merah NA, Foulkes-Crabbe DJ, Kushimo OT, Ajayi PA. Prediction of difficult laryngoscopy in a population of Nigerian obstetric patients. West Afr J Med 2004;23:38-41.
• 5. Shiga T Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology 2005;103:429-37.
• 6. Iohom G, Ronayne M, Cunningham AJ. Prediction of difficult tracheal intubation. Eur J Anaesthesiol 2003;20:31-6.
• 7. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987;42:487-90.
• 8. Karkouti K, Rose DK, Ferris LE, Wigglesworth DF, Meisami-Fard T, Lee H. Inter-observer reliability of ten tests used for predicting difficult tracheal intubation. Can J Anaesth 1996;43:554-9.
• 9. Adamus M, Jor O, Vavreckova T, Hrabalek L, Zapletalova J, Gabrhelik T, et al. Inter-observer reproducibility of 15 tests used for predicting difficult intubation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2011;155:275-81.
• 10. Yıldız TS, Culha TH, San S, Solak M, Toker M. Which Tests are the Most Reliable for Predicting Difficult Intubation? Turkish Journal of Anesthesiology and Reanimation. 2006;34:162-8.
• 11. Allahyary E, Ghaemei SR, Azemati S. Comparison of six methods for predicting difficult intubation in obstetric patients. IRCMJ 2008;10:197- 204.
• 12. 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. Anesth Analg 2003;96:595-9.
• 13. Hester CE, Dietrich SA, White SW, Secrest JA, Lindgren KR, Smith T. A comparison of preoperative airway assessment techniques: the modified Mallampati and the upper lip bite test. AANA J 2007;75:177-82.
• 14. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984;39:1105-11.
• 15. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003;98:1269-77.
• 16. 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. Can Anaesth Soc J 1985;32:429-34.
• 17. Frerk CM. Predicting difficult intubation. Anaesthesia 1991;46:1005-8.
• 18. 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. Anesth Analg 2005;101:284-9.
• 19. Salimi A, Farzanegan B, Rastegarpour A, Kolahi AA. Comparison of the upper lip bite test with measurement of thyromental distance for prediction of difficult intubations. Acta Anaesthesiol Taiwan 2008;46:61-5.
• 20. 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.