Comparison of Mallampati test in sitting position and in supine position for prediction of difficult tracheal intubation among adult patients who undergoing surgery under general anesthesia at Addis Ababa governmental hospitals from February –April 2021 :Comparative cross-sectional study
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Date
2021-04
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Addis Ababa University
Abstract
Background: Mallampati test is a method of assessing the airway for the prediction of difficult laryngoscopy and intubation. The sitting position is the routine position for this test and shows limited clinical value because of its low sensitivity and moderate specificity in predicting difficult intubation and laryngoscopy in other side supine position may improve its efficacy.
Mallampatii in supine positions for prediction of difficult tracheal intubation and/ or laryngoscopy was compared with sitting position.
Objective: To assess the Mallampati test in sitting and supine positions on predicting difficult laryngoscopy and intubation among Adult surgical patients undergoing general anesthesia among selected Addis Ababa governmental hospitals.
Method: a cross-sectional study was conducted at Addis Ababa governmental hospitals among 403 adult patients who underwent surgery that requires intubation. Samples were selected by using systemic random sampling technique. Mallampati test was performed in sitting and supine position during the preoperative period. Cormac and Lehans grade and Intubation Difficulty Scale were recorded at the time of intubation. Mallampati in both positions compared with Cormac and Lehans grade and Intubation Difficulty Scale by using chi-square test. Statistical package for social sciences (SPSS) software version 26.0 used for data analyses. A p-value of <
0.05 was considered statistically significant. Statistical measures including sensitivity, specificity, positive predictive values, and negative predictive values were calculated.
Result: the incidence of difficult laryngoscopy and intubation is 13.7% and 9.7% respectively.
Supine shows sensitivity of 78.8%; specificity of 93%; positive predictive value of 64.1 and negative predictive value of 96.5 whereas sitting shows sensitivity of 75%; specificity of 96.3%; positive predictive of 76.5 and negative predictive value of 96 concerning difficult laryngoscopy.
In relation to difficult intubation supine shows sensitivity of 78.4%; 89.8% specificity; 45.3 positive predictive value and 97.5 negative predictive value whereas sitting shows 73% sensitivity, 93% specificity, 52.9% PPV and 97% negative predictive value.
Conclusion and recommendation sitting have high specificity and positive predictive whereas supine has high sensitivity and negative predictive for prediction of difficult tracheal intubation and laryngoscopy. Despite its low positive predictive value supine have comparable prediction for difficult intubation and we can use it as alternative approach.
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Keywords
MALLAMPATII, difficult intubation; difficult laryngoscopy; supine; sitting