• Sindhu Khatiwada, Balkrishna Bhattarai, Krishna Pokharel, and Roshan Acharya.
• Department of Anesthesiology and Critical Care, BPKIHS, Dharan, Nepal.
• JNMA J Nepal Med Assoc. 2017 Jul 1; 56 (207): 314-8.

IntroductionVarious screening tests are done for predicting difficult laryngoscopy with variable diagnostic accuracy. Difficult laryngoscopy is being considered a surrogate indicator of difficult intubation, though it is not the exact measure of intubation difficulty. Our objectives were to find out the better predictor of difficult laryngoscopy amongst the routinely used tests and also to find the ability of difficult laryngoscopy to predict difficult intubation.MethodsThis prospective, observational study involved 314, ASA I/II adult patients requiring endotracheal intubation. Measurement of sternomental, thyromental and inter-incisor distances and gradings of mandibular protrusion and modified Mallampati were done. Statistical values including sensitivity and specificity of these tests were calculated to find the better predictor of difficult laryngoscopy. Cormack and Lehane laryngoscopy grade III/IV was defined as difficult laryngoscopy. Requirement of >3 attempts for endotracheal intubation was defined as difficult intubation.ResultsThe sensitivity of the Modified Mallampatti Test for predicting difficult laryngoscopy was highest, 83% compared to other tests. Total 12 (3.8%) patients had difficult laryngoscopy. Intubation was difficult in 7 (2.2%) patients, of which four had difficult laryngoscopy (P<0.001).ConclusionsModified Mallampati test was better for predicting difficult laryngoscopy compared to other bedside screening tests. Difficult laryngoscop could significantly predict difficult intubation in our patients.

22 keywords...

hide…