Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests for predicting difficult endotracheal intubation
Jigisha Prahladrai Badheka, Pratik M. Doshi, Ashutosh M. Vyas, Nirav Jentilal Kacha, Vandana S. Parmar
difficult laryngoscopy, ratio of height to thyromental distance, upper lip bite tests,Airway assessment tests
Citation Information :
Badheka JP, Doshi PM, Vyas AM, Kacha NJ, Parmar VS. Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests for predicting difficult endotracheal intubation. Indian J Crit Care Med 2016; 20 (1):3-8.
Background: Various anatomical measurements and noninvasive clinical tests, singly or in various combinations can be performed to predict difficult intubation. Upper lip bite test (ULBT) and ratio of height to thyromental distance (RHTMD) are claimed to have high predictability. Hence, we have conducted this study to compare the predictive value of ULBT and RHTMD with the following parameters: Mallampati grading, inter-incisor gap, thyromental distance, sternomental distance, head and neck movements, and horizontal length of mandible for predicting difficult intubation.
Materials and Methods: In this single blinded, prospective, observational study involving 170 adult patients of either sex belonging to American Society of Anesthesiologists physical Status I-III scheduled to undergo general anesthesia were recruited. All patients were subjected to the preoperative airway assessment and, the above parameters were recorded correlated with Cormack and Lehane grade and analyzed. The number of intubation attempts and use of intubation aids were also noted.
Results: ULBT and RHTMD had highest sensitivity (96.64%, 90.72%), specificity (82.35%, 80.39%), positive predictive value (92.74%, 91.53%), and negative predictive value (91.3%, 78.8%), respectively, compared to other parameters. While odds ratio and likelihood ratio >1 for all the tests.
Conclusion: ULBT can be used as a simple bedside screening test for prediction of difficult intubation, but it should be combined with other airway assessment tests for better airway predictability. RHTMD can also be used as an acceptable alternative.
Karalapillai D, Darvall J, Mandeville J, Ellard L, Graham J, Weinberg L. A review of video laryngoscopes relevant to the intensive care unit. Indian J Crit Care Med 2014;18:442-52.
Zuercher M, Ummenhofer W. Cardiac arrest during anesthesia. Curr Opin Crit Care 2008;14:269-74.
Braz LG, Módolo NS, do Nascimento P Jr., Bruschi BA, Castiglia YM, Ganem EM, et al. Perioperative cardiac arrest: A study of 53,718 anaesthetics over 9 yr from a Brazilian teaching hospital. Br J Anaesth 2006;96:569-75.
Safavi M, Honarmand A, Amoushahi M. Prediction of difficult laryngoscopy: Extended Mallampati score versus the MMT, ULBT and RHTMD. Adv Biomed Res 2014;3:133.
Iohom G, Ronayne M, Cunningham AJ. Prediction of difficult tracheal intubation. Eur J Anaesthesiol 2003;20:31-6.
Domi R. The best prediction test of difficult intubation. J Anaesthesiol Clin Pharmacol 2010;26:193-6.
Khan ZH, Maleki A, Makarem J, Mohammadi M, Khan RH, Zandieh A. A comparison of the upper lip bite test with hyomental/thyrosternal distances and mandible length in predicting difficulty in intubation: A prospective study. Indian J Anaesth 2011;55:43-6.
Shah PJ, Dubey KP, Yadav JP. Predictive value of upper lip bite test and ratio of height to thyromental distance compared to other multivariate airway assessment tests for difficult laryngoscopy in apparently normal patients. J Anaesthesiol Clin Pharmacol 2013;29:191-5.
Khan ZH, Arbabi S. Diagnostic value of the upper lip bite test in predicting difficulty in intubation with head and neck landmarks obtained from lateral neck X-ray. Indian J Anaesth 2013;57:381-6.
Samsoon GL, Young JR. Difficult tracheal intubation: A retrospective study. Anaesthesia 1987;42:487-90.
Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth 1988;61:211-6.
Merah NA, Wong DT, Ffoulkes-Crabbe DJ, Kushimo OT, Bode CO. Modified Mallampati test, thyromental distance and inter-incisor gap are the best predictors of difficult laryngoscopy in West Africans. Can J Anaesth 2005;52:291-6.
Schmitt HJ, Kirmse M, Radespiel-Troger M. Ratio of patient′s height to thyromental distance improves prediction of difficult laryngoscopy. Anaesth Intensive Care 2002;30:763-5.
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.
Mallampati SR. Clinical sign to predict difficult tracheal intubation (hypothesis). Can Anaesth Soc J 1983;30 (3 Pt 1):316-7.
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.
Honarmand A, Safavi M, Ansari N. A comparison of between hyomental distance ratios, ratio of height to thyromental, modified Mallamapati classification test and upper lip bite test in predicting difficult laryngoscopy of patients undergoing general anesthesia. Adv Biomed Res 2014;3:166.
Basunia SR, Ghosh S, Bhattacharya S, Saha I, Biswas A, Prasad A. Comparison between different tests and their combination for prediction of difficult intubation: An analytical study. Anesth Essays Res 2013;7:105-9.
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.
Krobbuaban B, Diregpoke S, Kumkeaw S, Tanomsat M. The predictive value of the height ratio and thyromental distance: Four predictive tests for difficult laryngoscopy. Anesth Analg 2005;101:1542-5.
Krishna HM, Agarwal M, Dali JS, Rampal P, Dua CK. Prediction of difficult laryngoscopy in Indian population: Role of ratio of patient′s height to thyromental distance. J Anaesthesiol Clin Pharmacol 2005;21:257-60.