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COMPARATIVE EVALUATION OF AIRWAY ASSESSMENT TESTS AND THEIR CORRELATION WITH LARYNGOSCOPY
- Author Details:
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Shikha Sharma
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Nandita Mehta
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D.S.Charak *
Background: It is an established fact that endotracheal intubation allows the best control of airway and
ventilation. Any difficulty in intubation which has not been anticipated and evaluated can lead to adverse
outcomes such as hypoxia, aspiration of vomitus etc. The preoperative assessment for recognition of difficult airway in advance is the best method of avoiding any disaster caused by the inability to maintain the airway.
Objectives: The main objective of this study was to assess the airway by various tests and then grade the view obtained at laryngoscopy, in all patients undergoing elective surgery requiring general anaesthesia and endotracheal intubation. Then to compare and correlate the laryngoscopic view obtained with the findings of airway assessment tests.
Material and Methods: A total 150 adult patients of either sex of ASA class I and II , undergoing elective
surgery for various procedures requiring general anaesthesia with endotracheal intubation were included in our study. Assessment of the airway was made by viewing the patient from lateral and anterolateral positions; viewing and palpating the neck anteriorly and laterally; extending and flexing the head and neck maximally; examining the mouth opening, teeth & oral cavity; and determining patency of nostrils. The following measurements were undertaken and recorded: a) Modified Mallampati Test, b) Thyromental Distance, c) Upper lip Bite Test, d) Head Extension, e) Wilson’s criteria. After induction of anaesthesia, laryngoscopy was performed in classical intubating position with McIntosh blade and the laryngoscopic grade was recorded as described by Cormack and Lehane. Statistical analysis was done for the usefulness of various tests (alone or in combination) for identifying difficult intubation.
Conclusion: No method either individual or in combination with other, identifies all cases of difficult
intubation. Wilson score and neck extension were most accurate individual methods. Combination of 3 tests is not required when 2 tests combined together can give better results.
Keywords: Airway, airway assessment tests, laryngoscopy, Cormack Lehane, tracheal intubation.