COMPARATIVE STUDY OF AIRWAY ASSESMENT WITH MODIFIED MALLAMPATTI CLASSIFICATION WITH CORMACK & LEHANE GRADING BY VIDEO LARYNGOSCOPY

Main Article Content

Dr. Tarun kumar Yadav
Dr. Suresh Singh
Dr. Syed Esam Mahmood

Keywords

Tracheal intubation, Modified Mallampati classification, Cormack & Lehane grading

Abstract

Background: Difficult laryngoscopic intubation increases the risk of complications such as sore throat, serious airway trauma and aspiration of gastric contents in a patient. This study was undertaken to compare the Modified Mallampatti scores with Cormack & Lehane Scoring by Video laryngoscope and to find the correlation of Modified Mallampatti Scoring with Cormack & Lehane Scoring through Video laryngoscope.


Methodology: This cross-sectional was conducted in the department of Anaesthesiology & CCM, Nehru Hospital, BRD Medical College, Gorakhpur, U.P. India. Patients aged between 18-65 years of either sex belonging to ASA grade I & II, undergoing elective procedure from all surgical specialities requiring endotracheal intubation by Anaesthetics videolaryngoscopy were enrolled.


Results: Out of 100 cases 78 (78%) patients were females and 22 (22%) were males. The cases with ASA grade I & II were in proportion 54% and 46% respectively. According to Mallampati classification the majority of cases were with Class 1 (65%), Class 2 (25%), Class 3 (8%) and Class 4 (2%) respectively. According to Cormack & Lehane grading the majority of cases belonged to grade 1 (60%), grade 2 (24%), grade 3 (12%) and grade 4 (4%) respectively. Out of 100 cases the modified Mallampati and CL grading shows same level correlation in 71 cases while in 29 cases it was different or non-correlated. Eighty eight cases had time taken less than 15 seconds while 12 cases took more than 15 seconds for Laryngoscopy and intubation.


Conclusion: Modified Mallampati scoring and Cormack & Lehane grading is a good predictor for tracheal intubation. Despite of videolaryngoscopy use the modified Mallampati classification did not correlate grade to grade with Cormack and Lehane grading in all cases. Regular use of videolaryngoscopy may improve the overall ease of intubation.

Abstract 202 | Pdf Downloads 77

References

1. Chapter 55, Airway Management in the adult. In: Miller's Anesthesia. 8th Edition. Elsevier, 2015. p. 1647-81.
2. Benumof JL. Management of the difficult adult airway. With special emphasis on awake tracheal intubation. Anesthesiology. 1991 Dec;75(6):1087-110. doi: 10.1097/00000542-199112000-00021. Erratum in: Anesthesiology 1993 Jan;78(1):224. PMID: 1824555.
3. Samsoon GLT, Young JRB. Difficult Tracheal intubation: a retrospective study.Anesthesia 1987;42:487-90
4. Lyon G. Failed Intubation: six year’s experience in a teaching maternity unit. Anaesthesia 1985; 40:759-62.
5. Lorraine M Sdrales, Ronald D.Miller- Miller’s Anesthesia Review-Saunders (2012 ) Second Edition Chapter 13 (Airway Management)
6. Hegde HV, Prasad KC, Bhat MT, et al. Airway difficulty in Mallampati ’class zero’ patients: a prospective double-blind observational study. Eur J Anaesthesiol 2012; 29:338–342.
7. Ezri T, Warters RD, Szmuk P, et al. The incidence of class "zero" airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade. Anesth Analg. 2001;93:1073–5
8. Kaki AM, AlMarkabi WA, Fawzi HM, Boker AM. Use of Airtraq, C-Mac, and Glidescope Laryngoscope is better than Macintosh in novice medical students’ hands: A manikin study. Saudi J Anaesthesia. 2011;5:576-381.
9. Channa AB. Video laryngoscopes. Saudi J Anaesth 2011;5:357-9
10. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A; 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. 2013 Feb;118(2):251-70.
11. doi: 10.1097/ALN.0b013e31827773b2. PMID: 23364566.
12. Asai T, Liu EH, Matsumoto S, et al. Use of the Pentax-AWS in 293 patients with difficult airways. Anesthesiology 2009; 110:898.
13. Aziz MF, Healy D, Kheterpal S, et al. Routine clinical practice effectiveness of the Glidescope in difficult airway management: an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions. Anesthesiology 2011; 114:34.
14. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A; 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. 2013 Feb;118(2):251-70.
15. doi: 10.1097/ALN.0b013e31827773b2. PMID: 23364566.
16. Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, O'Sullivan EP, Woodall NM, Ahmad I; Difficult Airway Society intubation guidelines working group. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015 Dec;115(6):827-48. doi: 10.1093/bja/aev371. Epub 2015 Nov 10. PMID: 26556848; PMCID: PMC4650961.
17. Fu- Shan Xue, Qian- Jin Liu, Hui-Xian Li, Ya- Yang Liu. Videolaryngoscopy assisted intubation — new era for airway management. J Anesth Perioper Med 2016; 3: 258-69.
18. Xue FS, Li HX, Liu YY, Yang GZ. Current evidence for the use of C-MAC videolaryngoscope in adult airway management: a review of the literature. Ther Clin Risk Manag. 2017 Jul 3;13:831-841. doi: 10.2147/TCRM.S136221. PMID: 28740393; PMCID: PMC5505682.
19. Hoshijima H, Mihara T, Maruyama K, Denawa Y, Mizuta K, Shiga T, Nagasaka H. C-MAC videolaryngoscope versus Macintosh laryngoscope for tracheal intubation: A systematic review and meta-analysis with trial sequential analysis. J Clin Anesth. 2018 Sep;49:53-62. doi: 10.1016/j.jclinane.2018.06.007. Epub 2018 Jun 9. PMID: 29894918.
20. Collins SR, Blank RS. Fiberoptic intubation: an overview and update. Respir Care. 2014 Jun;59(6):865-78; discussion 878-80. doi: 10.4187/respcare.03012. PMID: 24891196.
21. Asai T. Videolaryngoscopes: do they truly have roles in difficult airways? Anesthesiology. 2012 Mar;116(3):515-7. doi: 10.1097/ALN.0b013e318246e866. PMID: 22261794.
22. Asai T, Liu EH, Matsumoto S, Hirabayashi Y, Seo N, Suzuki A, Toi T, Yasumoto K, Okuda Y. Use of the Pentax-AWS in 293 patients with difficult airways. Anesthesiology. 2009;110:898–904.
23. Aziz MF, Dillman D, Fu R, Brambrink AM. Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway. Anesthesiology. 2012 Mar;116(3):629-36. doi: 10.1097/ALN.0b013e318246ea34. PMID: 22261795.
24. Jungbauer A, Schumann M, Brunkhorst V, Börgers A, Groeben H. Expected difficult tracheal intubation: a prospective comparison of direct laryngoscopy and video laryngoscopy in 200 patients. Br J Anaesth. 2009 Apr;102(4):546-50. doi: 10.1093/bja/aep013. Epub 2009 Feb 20. PMID: 19233881.
25. Malik MA, Subramaniam R, Maharaj CH, Harte BH, Laffey JG. Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation. Br J Anaesth. 2009 Nov;103(5):761-8. doi: 10.1093/bja/aep266. Epub 2009 Sep 24. PMID: 19783539.
26. Enomoto Y, Asai T, Arai T, Kamishima K, Okuda Y. Pentax-AWS, a new videolaryngoscope, is more effective than the Macintosh laryngoscope for tracheal intubation in patients with restricted neck movements: a randomized comparative study. Br J Anaesth. 2008 Apr;100(4):544-8. doi: 10.1093/bja/aen002. Epub 2008 Jan 31. PMID: 18238836.
27. Hirabayashi Y, Fujita A, Seo N, Sugimoto H. Cervical spine movement during laryngoscopy using the Airway Scope compared with the Macintosh laryngoscope. Anaesthesia. 2007 Oct;62(10):1050-5. doi: 10.1111/j.1365-2044.2007.05188.x. PMID: 17845658.
28. Mallampati SR. Clinical sign to predict difficult tracheal intubation (hypothesis). Can Anaesth Soc J. 1983 May;30(3 Pt 1):316-7. doi: 10.1007/BF03013818. PMID: 6336553.
29. Cohen SM, Laurito CE, Segil LJ. Examination of the hypopharynx predicts ease of laryngoscopic visualization and subsequent intubation: a prospective study of 665 patients. J Clin Anesth. 1992 Jul-Aug;4(4):310-4. doi: 10.1016/0952-8180(92)90136-o. PMID: 1419012.
30. Kaplan MB, Ward DS, Berci G. A new video laryngoscope-an aid to intubation and teaching. J Clin Anesth. 2002 Dec;14(8):620-6. doi: 10.1016/s0952-8180(02)00457-9. PMID: 12565125.
31. Jungbauer A, Schumann M, Brunkhorst V, Börgers A, Groeben H. Expected difficult tracheal intubation: a prospective comparison of direct laryngoscopy and video laryngoscopy in 200 patients. Br J Anaesth. 2009 Apr;102(4):546-50. doi: 10.1093/bja/aep013. Epub 2009 Feb 20. PMID: 19233881.
32. Su YC, Chen CC, Lee YK, Lee JY, Lin KJ. Comparison of video laryngoscopes with direct laryngoscopy for tracheal intubation: a meta-analysis of randomised trials. Eur J Anaesthesiol. 2011 Nov;28(11):788-95. doi: 10.1097/EJA.0b013e32834a34f3. PMID: 21897263.
33. Cavus E, Thee C, Moeller T, Kieckhaefer J, Doerges V, Wagner K. A randomised, controlled crossover comparison of the C-MAC videolaryngoscope with direct laryngoscopy in 150 patients during routine induction of anaesthesia. BMC Anesthesiol. 2011 Mar 1;11:6. doi: 10.1186/1471-2253-11-6. PMID: 21362173; PMCID: PMC3060123.
34. Hodgetts V, Danha RF, Mendonca C, Hillerman C (2011) A randomized Comparison of C-MAC Videolaryngscope Versus Macintosh Laryngoscope for Tracheal Intubation. J Anesthe Clinic Res 2:163. doi:10.4172/2155-6148.100016
35. Shashi Kiran Ds SK, Bala Subramanya H, Srinivas Murthy A, Bala Bhaskar S, Srinivasulu D. Comparative assessment of intubating conditions in adult patients using C-MAC® Video laryngoscope and Macintosh direct laryngoscope in routine intubations. Indian J Clin Anaesth 2017;4(2):160-164