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Christopher O Bode - One of the best experts on this subject based on the ideXlab platform.
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modified mallampati test Thyromental Distance and inter incisor gap are the best predictors of difficult laryngoscopy in west africans
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2005Co-Authors: Nkihu A Merah, David T Wong, Dorothy J O Ffoulkescrabbe, Olusola T Kushimo, Christopher O BodeAbstract:Purpose: To determine the ability to predict difficult visualization of the larynx (DVL) from the following preoperative airway predictive indices, in isolation and combination: modified Mallampati test (MMT), Thyromental Distance (TMD), sternomental Distance (SMD), horizontal length of the mandible (HLM) and inter-incisor gap (IIG). Methods: Three hundred and eighty consecutive patients undergoing general anesthesia were evaluated using the MMT, TMD, SMD, HLM and IIG and the cut-off points for the airway predictors were Mallampati III and IV; # 6.5 cm, # 13.5 cm, # 9.0 cm and # 4.0 cm respectively. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grades III and IV were considered difficult visualization. Sensitivity, specificity and positive predictive value for each airway predictor in isolation and in combination were determined. Logistic regression analysis was used to determine independent predictors of DVL. Results: Difficulty to visualize the larynx was found in 13 (3.4%) patients. The sensitivity, specificity and the positive predictive value for the five airway predictors were: MMT (61.5%; 98.4%; 57.1%), TMD (15.4%; 98.1%; 22.2%), SMD (0%; 100%; 0%), HLM (30.8%, 76.0%; 4.3%) and IIG (30.8%; 97.3%; 28.6%). The best combination of predictors was MMT/TMD/IIG with a sensitivity, specificity and positive predictive value of 84.6%; 94.6%; 35.5% respectively. Logistic regression analysis showed that weight, MMT, IIG and TMD were independent predictors of DVL. Conclusion: MMT, TMD and IIG appear to provide the optimal
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cardiothoracic anesthesia respiration and airway modified mallampati test Thyromental Distance and inter incisor gap are the best predictors of difficult laryngoscopy in west africans
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2005Co-Authors: Nkihu A Merah, David T Wong, Dorothy J O Ffoulkescrabbe, Olusola T Kushimo, Christopher O BodeAbstract:Determiner la capacite de predire les difficultes de visuali-sation du larynx (DVL) a partir des indices preoperatoires suivants, pris isolement et en combinaison : le test de Mallampati modifie (TMM), la Distance thyromentonniere (DTM), la Distance sternomentionniere (DSM), la longueur horizontale de la mandibule (LHM) et l’espace inter-incisive (EII). Nous avons evalue 380 patients consecutifs devant subir une anesthesie generale en utilisant le TMM, la DTM, la DSM et l’EII; les points limites des predicteurs d’intubation ont ete les classes de Mallampati III et IV; # 6,5 cm, # 13,5 cm, # 9,0 cm et # 4,0 cm respectivement. La visualisation laryngoscopique directe a ete cotee selon la classification de Cormack et Lehane (CL). Les classes de CL III et IV etaient une visualisation difficile. La sensibilite, la specificite et la valeur predictive positive de chaque predicteur d’intubation pris isole-ment et en combinaison ont ete determines. On a determine les pre-dicteurs independants des DVL par l’analyse de regression logistique. La visualisation du larynx a ete difficile chez 13 (3,4 %) patients. La sensibilite, la specificite et la valeur predictive positive des cinq predicteurs d’intubation ont ete : le TMM (61,5 %; 98,4 %; 57,1 %), la DTM (15,4 %; 98,1 %; 22,2 %), la DSM (0 %; 100 %; 0 %), la LHM (30,8 %; 76,0 %; 4,3 %) et l’EII (30,8 %; 97,3 %; 28,6 %). La meilleure combinaison de predicteurs a ete TMM/DTM/EII avec une sensibilite, une specificite et une valeur pre-dictive positive de 84,6 %; 94,6 %; 35,5 % respectivement. L’analyse de regression logistique a montre que le poids, le TMM, l’EII et la DTM etaient des predicteurs independants des DVL.
Harald Herkner - One of the best experts on this subject based on the ideXlab platform.
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bedside tests for predicting difficult airways an abridged cochrane diagnostic test accuracy systematic review
Anaesthesia, 2019Co-Authors: Dominik Roth, Nathan L Pace, Anna Lee, Karen Hovhannisyan, Alexandramaria Warenits, Jasmin Arrich, Harald HerknerAbstract:Although bedside screening tests are routinely used to identify people at high risk of having a difficult airway, their clinical utility is unclear. We estimated the diagnostic accuracy of commonly used bedside examination tests for assessing the airway in adult patients without apparent anatomical abnormalities scheduled to undergo general anaesthesia. We searched for studies that reported our pre-specified bedside index screening tests against a reference standard, published in any language, from date of inception to 16 December 2016, in seven bibliographic databases. We included 133 studies (127 cohort type and 6 case–control) involving 844,206 participants. Overall, their methodological quality (according to QUADAS-2, a standard tool for assessing quality of diagnostic accuracy studies) was moderate to high. Our pre-specified tests were: the Mallampati test (6 studies); modified Mallampati test (105 studies); Wilson risk score (6 studies); Thyromental Distance (52 studies); sternomental Distance (18 studies); mouth opening test (34 studies); and the upper lip bite test (30 studies). Difficult facemask ventilation, difficult laryngoscopy, difficult intubation and failed intubation were the reference standards in seven, 92, 50 and two studies, respectively. Across all reference standards, we found all index tests had relatively low sensitivities, with high variability, but specificities were consistently and markedly higher than sensitivities. For difficult laryngoscopy, the sensitivity and specificity (95%CI) of the upper lip bite test were 0.67 (0.45–0.83) and 0.92 (0.86–0.95), respectively; upper lip bite test sensitivity (95%CI) was significantly higher than that for the mouth opening test (0.22, 0.13–0.33; p < 0.001). For difficult tracheal intubation, the modified Mallampati test had a significantly higher sensitivity (95%CI) at 0.51 (0.40–0.61) compared with mouth opening (0.27, 0.16–0.41; p < 0.001) and Thyromental Distance (0.24, 0.12–0.43; p < 0.001). Although the upper lip bite test showed the most favourable diagnostic test accuracy properties, none of the common bedside screening tests is well suited for detecting unanticipated difficult airways, as many of them are missed. (Less)
Nkihu A Merah - One of the best experts on this subject based on the ideXlab platform.
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modified mallampati test Thyromental Distance and inter incisor gap are the best predictors of difficult laryngoscopy in west africans
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2005Co-Authors: Nkihu A Merah, David T Wong, Dorothy J O Ffoulkescrabbe, Olusola T Kushimo, Christopher O BodeAbstract:Purpose: To determine the ability to predict difficult visualization of the larynx (DVL) from the following preoperative airway predictive indices, in isolation and combination: modified Mallampati test (MMT), Thyromental Distance (TMD), sternomental Distance (SMD), horizontal length of the mandible (HLM) and inter-incisor gap (IIG). Methods: Three hundred and eighty consecutive patients undergoing general anesthesia were evaluated using the MMT, TMD, SMD, HLM and IIG and the cut-off points for the airway predictors were Mallampati III and IV; # 6.5 cm, # 13.5 cm, # 9.0 cm and # 4.0 cm respectively. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grades III and IV were considered difficult visualization. Sensitivity, specificity and positive predictive value for each airway predictor in isolation and in combination were determined. Logistic regression analysis was used to determine independent predictors of DVL. Results: Difficulty to visualize the larynx was found in 13 (3.4%) patients. The sensitivity, specificity and the positive predictive value for the five airway predictors were: MMT (61.5%; 98.4%; 57.1%), TMD (15.4%; 98.1%; 22.2%), SMD (0%; 100%; 0%), HLM (30.8%, 76.0%; 4.3%) and IIG (30.8%; 97.3%; 28.6%). The best combination of predictors was MMT/TMD/IIG with a sensitivity, specificity and positive predictive value of 84.6%; 94.6%; 35.5% respectively. Logistic regression analysis showed that weight, MMT, IIG and TMD were independent predictors of DVL. Conclusion: MMT, TMD and IIG appear to provide the optimal
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cardiothoracic anesthesia respiration and airway modified mallampati test Thyromental Distance and inter incisor gap are the best predictors of difficult laryngoscopy in west africans
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2005Co-Authors: Nkihu A Merah, David T Wong, Dorothy J O Ffoulkescrabbe, Olusola T Kushimo, Christopher O BodeAbstract:Determiner la capacite de predire les difficultes de visuali-sation du larynx (DVL) a partir des indices preoperatoires suivants, pris isolement et en combinaison : le test de Mallampati modifie (TMM), la Distance thyromentonniere (DTM), la Distance sternomentionniere (DSM), la longueur horizontale de la mandibule (LHM) et l’espace inter-incisive (EII). Nous avons evalue 380 patients consecutifs devant subir une anesthesie generale en utilisant le TMM, la DTM, la DSM et l’EII; les points limites des predicteurs d’intubation ont ete les classes de Mallampati III et IV; # 6,5 cm, # 13,5 cm, # 9,0 cm et # 4,0 cm respectivement. La visualisation laryngoscopique directe a ete cotee selon la classification de Cormack et Lehane (CL). Les classes de CL III et IV etaient une visualisation difficile. La sensibilite, la specificite et la valeur predictive positive de chaque predicteur d’intubation pris isole-ment et en combinaison ont ete determines. On a determine les pre-dicteurs independants des DVL par l’analyse de regression logistique. La visualisation du larynx a ete difficile chez 13 (3,4 %) patients. La sensibilite, la specificite et la valeur predictive positive des cinq predicteurs d’intubation ont ete : le TMM (61,5 %; 98,4 %; 57,1 %), la DTM (15,4 %; 98,1 %; 22,2 %), la DSM (0 %; 100 %; 0 %), la LHM (30,8 %; 76,0 %; 4,3 %) et l’EII (30,8 %; 97,3 %; 28,6 %). La meilleure combinaison de predicteurs a ete TMM/DTM/EII avec une sensibilite, une specificite et une valeur pre-dictive positive de 84,6 %; 94,6 %; 35,5 % respectivement. L’analyse de regression logistique a montre que le poids, le TMM, l’EII et la DTM etaient des predicteurs independants des DVL.
Dominik Roth - One of the best experts on this subject based on the ideXlab platform.
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bedside tests for predicting difficult airways an abridged cochrane diagnostic test accuracy systematic review
Anaesthesia, 2019Co-Authors: Dominik Roth, Nathan L Pace, Anna Lee, Karen Hovhannisyan, Alexandramaria Warenits, Jasmin Arrich, Harald HerknerAbstract:Although bedside screening tests are routinely used to identify people at high risk of having a difficult airway, their clinical utility is unclear. We estimated the diagnostic accuracy of commonly used bedside examination tests for assessing the airway in adult patients without apparent anatomical abnormalities scheduled to undergo general anaesthesia. We searched for studies that reported our pre-specified bedside index screening tests against a reference standard, published in any language, from date of inception to 16 December 2016, in seven bibliographic databases. We included 133 studies (127 cohort type and 6 case–control) involving 844,206 participants. Overall, their methodological quality (according to QUADAS-2, a standard tool for assessing quality of diagnostic accuracy studies) was moderate to high. Our pre-specified tests were: the Mallampati test (6 studies); modified Mallampati test (105 studies); Wilson risk score (6 studies); Thyromental Distance (52 studies); sternomental Distance (18 studies); mouth opening test (34 studies); and the upper lip bite test (30 studies). Difficult facemask ventilation, difficult laryngoscopy, difficult intubation and failed intubation were the reference standards in seven, 92, 50 and two studies, respectively. Across all reference standards, we found all index tests had relatively low sensitivities, with high variability, but specificities were consistently and markedly higher than sensitivities. For difficult laryngoscopy, the sensitivity and specificity (95%CI) of the upper lip bite test were 0.67 (0.45–0.83) and 0.92 (0.86–0.95), respectively; upper lip bite test sensitivity (95%CI) was significantly higher than that for the mouth opening test (0.22, 0.13–0.33; p < 0.001). For difficult tracheal intubation, the modified Mallampati test had a significantly higher sensitivity (95%CI) at 0.51 (0.40–0.61) compared with mouth opening (0.27, 0.16–0.41; p < 0.001) and Thyromental Distance (0.24, 0.12–0.43; p < 0.001). Although the upper lip bite test showed the most favourable diagnostic test accuracy properties, none of the common bedside screening tests is well suited for detecting unanticipated difficult airways, as many of them are missed. (Less)
Mudassir A Bhat - One of the best experts on this subject based on the ideXlab platform.
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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
Journal of Anaesthesiology Clinical Pharmacology, 2019Co-Authors: Pratibha Panjiar, Anjali Kochhar, Kharat Mohammed Bhat, Mudassir A BhatAbstract:Background and Aims: Preoperative airway assessment to predict patients with difficult laryngoscopy is always crucial for anesthesiologists. Several predictive tests have been studied by various authors in quest of finding the best airway predictor. Recently, a new airway predictor, Thyromental height test (TMHT) has been reported to have good predictive value in assessing difficult airway. We conducted this study with primary aim to evaluate the diagnostic accuracy of TMHT and to compare it with other established airway predictors, such as ratio of height to Thyromental Distance (RHTMD), Thyromental Distance (TMD), and modified Mallampati test (MMT) for predicting difficult laryngoscopy. Material and Methods: This prospective, observational study was conducted in 550 patients of either sex aged >18 years scheduled for elective surgery under general anesthesia. The patients' airway was assessed preoperatively by two anesthetists. Standard anesthetic protocol was followed in all the patients. The laryngoscopic view was graded according to Cormack–Lehane scale. The receiver operating characteristic (ROC) curve was used to calculate the ideal cut off values for TMHT and RHTMD. Standard formulae were used to calculate validity indexes. Results: The incidence of difficult laryngoscopy was 10%. The cut-off value for TMHT and RHTMD were 5.1 cm and 19.5, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TMHT were 78.18%, 93.94%, 58.90%, and 97.48%, respectively. The highest sensitivity, PPV, and NPV were observed with TMHT as compared with RHTMD, TMD, and MMT (P Conclusions: TMHT is the best predictive test with highest accuracy and odds ratio for predicting difficult airway out of all predictive tests evaluated.