Mehmet Turan İNAL, İlker YILDIRIM, Dilek MEMİŞ, F. Nesrin TURAN

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

Background: Pregnancy-induced anatomical andphysiological changes in the airway make airwaymanagement difficult in obstetric patients; thus,preoperative evaluation of the airway is important forobstetric patients.Aims: To determine the effectiveness of the modifiedMallampati test; the interincisor, sternomental andthyromental distances and the upper limb bite test.The second aim was to assess the effectiveness of thecombination of the upper limb bite test with the othertests in obstetric patients.Study Design: Cross-sectional study.Methods: Pregnant women (n=250) scheduled forcaesarean section were analysed. The patients' ages,heights and weights were collected. Preoperative airwayevaluation was done by using a modified version ofthe Mallampati test. The interincisor, sternomental andthyromental distances were measured, and the upper limbbite test was performed. The laryngoscopy difficulty wasevaluated by using Cormack-Lehane classification.Results: No statistically significant differenceswere found between groups in age, height or weight(p>0.05). The modified Mallampati test and interincisor,sternomental and thyromental distances revealed a lowernumber of easy intubations than that determined by theCormack-Lehane classification and a higher numberof difficult intubations than the actual number of cases(p

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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.
21. Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth 1988; 61:211-6.
22. Asık I, Goktug A, Canakcı N. The relationship of different evaluation tests with difficult intubation. Journal of Anesthesiology 2000;8:188-92.
23. Al Ramadhani S, Mohamed LA, Rocke DA, Gouws E. Sternomental distance as the sole predictor of difficult laryngoscopy in obstetric anaesthesia. Br J Anaesth 1996;77:312-6.
24. Savva D. Prediction of difficult tracheal intubation. Br J Anaesth 1994;73:149-53.
25. Tse JC, Rimm EB, Hussain A. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study. Anesth Analg 1995;8:254-8.
26. Wong SH, Hung CT. Prevalence and prediction of difficult intubation in Chinese women. Anaesth Intensive Care 1999;27:49-52.