mallampati score correlation with laryngoscopic view

[GGYY]

Hey guys,

Ok, don't make fun of me for asking this, I've only done 5 months of anesthesia.

What do you guys think is the correlation of MP score and laryngoscopic view. No correlation, little correlation?

Also, for those of you who trained/is training in hospitals with an OMFS presence, do you guys do a lot of OMS cases?

thanks!

---

Members don't see this ad.

 

[ambiturner]

the original papers by mallampati cited high sensitivity and specificity but multiple repeat studies since (like this one: http://www.ncbi.nlm.nih.gov/pubmed/1595845) have not had as glowing results. there are a bunch of other tests that are better predictors, if i recall correctly i think being unable to extend your lower teeth past the uppers is the best predictor of a difficult airway.

regarding OMFS cases, we do have them at my program and they can be fun if you get to do a nasal DL or fiberoptic, but they also tend to be pretty long and slow. they can also be tricky b/c some parts of the procedure itself are very stimulating, but postoperatively there is very little pain which necessitates judicious narcotic use.

 

[periopdoc]

In isolation, Mallampati Score is poorly correlated. Combined with other findings, especially short TMD, the correlation improves.

Personally, I find it to be a borderline useless test. Since at least the start of my CA-3 year, I can't think of a case where MP score gave me any additional information than what I could garner from assessing the patient's face during the interview.


- pod

 

[Gaseous Clay]

I agree with the other two posters. MP by itself is not that useful. Not to knock you, but even a CA-1 should have a firm understanding of a good airway exam. The main things I look for:

1) Mouth opening
2) TMD
3) Teeth - very poor, rotten? big protruding incisors? Buck teeth?
4) Mandibular subluxation as ambi pointed out
5) neck circumference
6) MP score
7) neck extension - this one is probably ignored the most. A skinny MP 1 can be quite difficult if they have an extremely stiff neck

There are probably a few more the Academic guys like to point out but if you keep all of these in mind, this should help you. With that said, fortunately having the Glidescope has changed the way we handle the "difficult" airway and certainly has helped bail me out when an airway is more difficult than anticipated.

 

[Gern Blansten]

in isolation, mallampati score is poorly correlated. Combined with other findings, especially short tmd, the correlation improves.

Personally, i find it to be a borderline useless test. Since at least the start of my ca-3 year, i can't think of a case where mp score gave me any additional information than what i could garner from assessing the patient's face during the interview.


- pod

+1

 

[pgg]

Mallampati's paper is what, 30 years old now?

People are a lot fatter now. I think obesity affects MP score more than it makes airways difficult. Ie, maybe the average 1983 MP3 isn't comparable to a 2012 MP3.

 

[Dwindlin]

Mallampati's paper is what, 30 years old now?

People are a lot fatter now. I think obesity affects MP score more than it makes airways difficult. Ie, maybe the average 1983 MP3 isn't comparable to a 2012 MP3.

Has anyone looked at this? I think it would be interesting to see this, someone who enjoys research should get on this.

 

[deleted59964]

regarding OMFS cases, ... they can also be tricky b/c some parts of the procedure itself are very stimulating, but postoperatively there is very little pain which necessitates judicious narcotic use.

do you use remifentanil?

 

[ambiturner]

do you use remifentanil?

for LeFortes and the like yes, i really can't imagine doing it without remi, maybe just fentanyl boluses? actually at our place you could probably use anything since they let their junior residents close the mouth which can take well over an hour...

 

[ssmallz]

In isolation, Mallampati Score is poorly correlated. Combined with other findings, especially short TMD, the correlation improves.

Personally, I find it to be a borderline useless test. Since at least the start of my CA-3 year, I can't think of a case where MP score gave me any additional information than what I could garner from assessing the patient's face during the interview.


- pod

It's funny that you mention this because I was just thinking the same thing a few weeks ago. In residency I was very diligent about the MP score and as an attending, I'm way more concerned w/the external facial anatomy. The 2 people I had to AFOI, I mad the decision based on other factors.

I feel a good MP score means that intubation should be pretty easy but a bad MP score does necessarily mean intubation will be difficult. For the residents out there, The key things to remember when evaluating is can you ventilate or not? If you can, you've likely got enough tools in your bag to intubate, if you can't be afraid.

 

[cincincyreds]

I agree with the other two posters. MP by itself is not that useful. Not to knock you, but even a CA-1 should have a firm understanding of a good airway exam. The main things I look for:

1) Mouth opening
2) TMD
3) Teeth - very poor, rotten? big protruding incisors? Buck teeth?
4) Mandibular subluxation as ambi pointed out
5) neck circumference
6) MP score
7) neck extension - this one is probably ignored the most. A skinny MP 1 can be quite difficult if they have an extremely stiff neck

There are probably a few more the Academic guys like to point out but if you keep all of these in mind, this should help you. With that said, fortunately having the Glidescope has changed the way we handle the "difficult" airway and certainly has helped bail me out when an airway is more difficult than anticipated.

I agree with #7. I get very nervous when someone can't extand their neck.

#8 should be the gullet sign. Someone with gullet for some weird reason can be difficult to intubate, especially if they have an overbite and poor neck extension. Ankylsoing spondylitis really scares me, especially when I need to place a DLETT into them fora thoracotomy.