Comparison of Upper Lip Bite Test with Modified Mallampati Classification for Prediction of Difficult Endotracheal Intubation

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Gurung Purna Kala
Singh Arun Kumar
Gupta Sandeep
Ali Khawar
Iqbal Mazar


Background: Prediction of difficult airway and its management are fundamental skills for the safe conduct of anesthesia. Failure in recognizing difficult airway before induction of anesthesia can lead to disastrous complications ranging from sore throat
to serious airway trauma to hypoxic brain damage or death. This study was conducted to compare upper lip bite (ULBT) and modified Mallampati (MMC) tests in prediction of difficult endotracheal intubation.
Methods: One hundred ASA I and II patients scheduled for elective surgical procedure requiring endotracheal intubation were prospec-tively recruited in this study. All the patients airway were assessed pre-operatively with ULBT and MMC tests and laryngeal view grading by Cormack-Lehane's classification was recorded by anesthesiologist blind to preoperative airway
assessment. Sensitivity, specificity, positive and negative predictive values; and accuracy of ULBT and MMC were calculated; and Z test for statistical difference between them was used.
Results: The incidence of difficult intubation in our study was 6% (n=6). The specificity and accuracy of ULBT (98.9% and 95% respectively) were significantly higher than MMC (77.6% and 76% respectively), each with P value < 0.001. However,there was no significant difference in sensitivity and negative predictive value between the two tests. The difference of positive predictive
value for ULBT (66.6%) and MMC (12.5%) was though insignificant with p-value 0.053, but could not be ignored.
Conclusion: Our study concluded that ULBT serves as a good predictor in predicting difficult laryngoscopic intubation than MMC.

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