PREDICTION OF INCIDENCE OF DIFFICULT INTUBATION BY MODIFIED MALLAMPATI TEST (MMT) AND INTUBATION DIFFICULTY SCALE (IDS) SCORE IN PATIENTS UNDERGOING GENERAL ANAESTHESIA
Main Article Content
Keywords
Intubation Difficulty Scale, Mallampati, Airway.
Abstract
BACKGROUND: Difficult airway management is major cause of morbidity and mortality in anaesthesia practice. The prevalence of difficult intubation - 0.1% to 10.1%. The aim of current study was to predict incidence of difficult intubation using Modified Mallampati test and Intubation Difficulty Scale.
MATERIALS & METHODS: After Institutional ethical committee approval, a hospital based observational study was done by recruiting 70 subjects with the American society of anaesthesiologists Class 1, 2 undergoing elective surgeries under general anaesthesia by endotracheal intubation. Modified Mallampati Test (MMT) was assessed preoperatively. Intubation difficulty scale (IDS) score was recorded during intubation. The primary outcome includes the prediction of difficult intubation as described by IDS score, patients were classified into two groups with IDS score of ≥5 and <5 as the difficult and easy intubation groups, respectively. Data analysed using Receiver operating characteristic (ROC) curve and Area under Curve (AUC).
RESULTS: The mean age of subjects was 36.81±13.08 years. The percentage of difficult intubation was 5.7% by IDS and 28.6% by MMT. 94.2% had IDS score<5. Age and Body mass index correlates with increased IDS score predicting difficult intubation (p≤0.05; r = 0.499, r = 0.51) respectively. The AUC for IDS score was 0.727 (p = 0.003) which was statistically significant. The sensitivity of the IDS score was 15% and specificity was 98%.
CONCLUSION: The MMT being the gold standard and IDS scoring system a validated method based on subjective and objective criteria, used to evaluate a global degree of intubation difficulty to decrease the incidence of airway related complications by using simple maneuvers and techniques.
MATERIALS & METHODS: After Institutional ethical committee approval, a hospital based observational study was done by recruiting 70 subjects with the American society of anaesthesiologists Class 1, 2 undergoing elective surgeries under general anaesthesia by endotracheal intubation. Modified Mallampati Test (MMT) was assessed preoperatively. Intubation difficulty scale (IDS) score was recorded during intubation. The primary outcome includes the prediction of difficult intubation as described by IDS score, patients were classified into two groups with IDS score of ≥5 and <5 as the difficult and easy intubation groups, respectively. Data analysed using Receiver operating characteristic (ROC) curve and Area under Curve (AUC).
RESULTS: The mean age of subjects was 36.81±13.08 years. The percentage of difficult intubation was 5.7% by IDS and 28.6% by MMT. 94.2% had IDS score<5. Age and Body mass index correlates with increased IDS score predicting difficult intubation (p≤0.05; r = 0.499, r = 0.51) respectively. The AUC for IDS score was 0.727 (p = 0.003) which was statistically significant. The sensitivity of the IDS score was 15% and specificity was 98%.
CONCLUSION: The MMT being the gold standard and IDS scoring system a validated method based on subjective and objective criteria, used to evaluate a global degree of intubation difficulty to decrease the incidence of airway related complications by using simple maneuvers and techniques.
References
[1] Practice guidelines for management of the difficult airway. A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 1993;78(3):597-602.
[2] Benumof JL. Management of the difficult adult airway. With special emphasis on awake tracheal intubation. Anesthesiology 1991;75:1087-110.
[3] Enterlein G, Byhahn C. Practice guidelines for management of the difficult airway: update by the American Society of Anesthesiologists task force. Anaesthesist 2013;62:832-5.
[4] 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(5):1269-77.
[5] Apfelbaum JL, Hagberg CA, Caplan RA, et al. 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;118 (2):251-70.
[6] Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;136(1):31-81.
[7] Adnet F, Borron SW, Racine SX, et al. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology 1997;87:1290-7.
[8] Nasa VK, Kamath SS. Risk Factors assessment of the difficult intubation using intubation difficulty scale (IDS). J Clin Diagn Res 2014;8(7):GC01-3.
[9] Koh W, Kim H, Kim K, et al. Encountering unexpected difficult airway: relationship with the intubation difficulty scale. Korean J Anesthesiol 2016;69(3):244-9.
[10] Vidhya S, Sharma B, Swain BP, et al. Comparison of sensitivity, specificity, and accuracy of Wilson's score and intubation prediction score for prediction of difficult airway in an eastern Indian population-a prospective single-blind study. J Family Med Prim Care 2020;9:1436-41.
[11] Hogan K, Rusy D, Springman SR. Difficult laryngoscopy and diabetes mellitus. Anesth Analg 1988;67:1162-5.
[12] Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985;32:429-34.
[13] Williams KN, Carli F, Cormack RS. Unexpected, difficult laryngoscopy: a prospective survey in routine general surgery. Br J Anaesth 1991;66:38-44.
[14] Van Zundert A, Pieters B, Doerges V, et al. Videolaryngoscopy allows a better view of the pharynx and larynx than classic laryngoscopy. Br J Anaesth 2012;109:1014-5.
[15] Rothfield KP, Russo SG. Videolaryngoscopy: should it replace direct laryngoscopy? A pro-con debate. J Clin Anesth 2012;24(7):593-7.
[2] Benumof JL. Management of the difficult adult airway. With special emphasis on awake tracheal intubation. Anesthesiology 1991;75:1087-110.
[3] Enterlein G, Byhahn C. Practice guidelines for management of the difficult airway: update by the American Society of Anesthesiologists task force. Anaesthesist 2013;62:832-5.
[4] 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(5):1269-77.
[5] Apfelbaum JL, Hagberg CA, Caplan RA, et al. 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;118 (2):251-70.
[6] Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;136(1):31-81.
[7] Adnet F, Borron SW, Racine SX, et al. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology 1997;87:1290-7.
[8] Nasa VK, Kamath SS. Risk Factors assessment of the difficult intubation using intubation difficulty scale (IDS). J Clin Diagn Res 2014;8(7):GC01-3.
[9] Koh W, Kim H, Kim K, et al. Encountering unexpected difficult airway: relationship with the intubation difficulty scale. Korean J Anesthesiol 2016;69(3):244-9.
[10] Vidhya S, Sharma B, Swain BP, et al. Comparison of sensitivity, specificity, and accuracy of Wilson's score and intubation prediction score for prediction of difficult airway in an eastern Indian population-a prospective single-blind study. J Family Med Prim Care 2020;9:1436-41.
[11] Hogan K, Rusy D, Springman SR. Difficult laryngoscopy and diabetes mellitus. Anesth Analg 1988;67:1162-5.
[12] Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985;32:429-34.
[13] Williams KN, Carli F, Cormack RS. Unexpected, difficult laryngoscopy: a prospective survey in routine general surgery. Br J Anaesth 1991;66:38-44.
[14] Van Zundert A, Pieters B, Doerges V, et al. Videolaryngoscopy allows a better view of the pharynx and larynx than classic laryngoscopy. Br J Anaesth 2012;109:1014-5.
[15] Rothfield KP, Russo SG. Videolaryngoscopy: should it replace direct laryngoscopy? A pro-con debate. J Clin Anesth 2012;24(7):593-7.
Article Sidebar
Published
Apr 16, 2025
Article Details
How to Cite
Dr. Mamatha V, Dr. Mahima Bahuguni, Dr. Prakash D.B, & Dr. Santhosh M.S. (2025). PREDICTION OF INCIDENCE OF DIFFICULT INTUBATION BY MODIFIED MALLAMPATI TEST (MMT) AND INTUBATION DIFFICULTY SCALE (IDS) SCORE IN PATIENTS UNDERGOING GENERAL ANAESTHESIA. Journal of Population Therapeutics and Clinical Pharmacology, 32(3), 477-484. https://doi.org/10.53555/fq831j55
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Author Biographies
Dr. Mamatha V
Senior Resident, Department of Anaesthesiology, JSS Medical College & Hospital, Mysore, Karnataka, India
Dr. Mahima Bahuguni
Senior Resident, Department of Anaesthesiology, JSS Medical College & Hospital, Mysore, Karnataka, India
Dr. Prakash D.B
Professor & HOD, Department of Anaesthesiology, JJM Medical College, Davanagere, Karnataka, India
Dr. Santhosh M.S
Assistant Professor, Department of Orthopaedics, JSS Medical College & Hospital, Mysore Karnataka, India
How to Cite
Dr. Mamatha V, Dr. Mahima Bahuguni, Dr. Prakash D.B, & Dr. Santhosh M.S. (2025). PREDICTION OF INCIDENCE OF DIFFICULT INTUBATION BY MODIFIED MALLAMPATI TEST (MMT) AND INTUBATION DIFFICULTY SCALE (IDS) SCORE IN PATIENTS UNDERGOING GENERAL ANAESTHESIA. Journal of Population Therapeutics and Clinical Pharmacology, 32(3), 477-484. https://doi.org/10.53555/fq831j55