title: Is the modified Mallampati test performed in supine position a reliable predictor of difficult tracheal intubation?
abstract: Management of the airway is central to the practice of anesthesia. Several bedside airway assessment methods have been proposed for preoperative identification of patients who are difficult to intubate. The modified Mallampati test (MMT) remains a time-tested technique to date for recognizing an anticipated difficult tracheal intubation as assessed by Cormack-Lehane grade. Both Mallampati and its further modification by Samsoon and Young evaluate patients in the seated position. Recently a study mentioned a change in MMT score from sitting to supine position toward the higher side. However, there is a lack of data regarding the relationship of positional change in MMT with Cormack-Lehane grade. The aim of this prospective study was to assess if MMT score observed in sitting or supine position is a better predictor of difficult tracheal intubation. One hundred and twenty-three patients of ASA physical status I and II, aged 18-60 years, who were scheduled to undergo various neurosurgical procedures were enrolled for the study. We found that the MMT in supine position has a higher positive predictive value and is associated with more true positives as compared to MMT in the sitting position.
authors.affiliation: Department of Neuroanesthesiology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Bindra
authors.forename: Hemanshu
authors.initials: H
authors.lastname: Prabhakar
authors.forename: Gyaninder Pal
authors.initials: GP
authors.lastname: Singh
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Ali
authors.forename: Vasudha
authors.initials: V
authors.lastname: Singhal
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000145:classification*; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D016683:Supine Position / Q000502:physiology*; D014132:Trachea / Q000033:anatomy & histology*; D055815:Young Adult