No abstract

BACKGROUND: This study was carried out to evaluate usefulness of preoperative Mallampati & Wilson's score grading as a predictor for difficult laryngoscopy & intubation. AIMS: To determine the accuracy of the modified Mallampati test and Wilson score for predicting difficult tracheal intubation and correlation with Cormack Lehane grading. METHODS: This prospective randomized cross sectional Study carried out in 200 patients, posted for surgical procedure under GA with ETT intubation. Preoperative airway assessment using Mallampati grading (MPG) & Wilson score done. Conventional anesthesia technique followed. Cormack Lehane grading done at laryngoscopy & correlated with previous scores for each patient. RESULTS: A MPG of I/II was found in 140 patients (70%), while 60 patients (30%) were class III/IV. 138 patients (69%) had a Wilson score of 0/1, while 60(30%) had a score of 2/3 and 2 patients (1%) scored ≥4. One hundred & eighty patients (90%) were classified as Cormack-Lehane grade I/II, while 20 patients (10%) were considered grade III/IV. Of the 60 patients with a Wilson score of 2/3, 6 cases (10%) two attempts were required and in 2 cases (3.3%) in spite of more than two attempts intubation proved impossible with the conventional laryngoscope, articulated McCoy blade was used. Two patients with a Wilson score ≥4 were intubated with gum elastic bougie, using articulated McCoy blade. Overall, out of 200, in 6 patients (3%) two attempts of intubation was required and 4 patients (2%) intubation required the use of some kind of gadget other than conventional laryngoscope and more than 2 attempts. The correlation between the Cormack-Lehane classification and the number of endotracheal intubation attempts showed that of the 180 patients with I / II grade, 4 patients (1.3%) two attempts were required. Of the 20 patients classified as Cormack-Lehane III/IV, 4 cases (20%) intubation proved impossible with conventional technique. This correlation was statistically significant. DISCUSSION: The Wilson score can successfully predict the patients in whom laryngoscopy may prove difficult (Wilson 2/3) (p=0.01). This reflects the good sensitivity. CONCLUSIONS: Wilson score, despite being seldom used in clinical practice, is a highly sensitive predictor of a difficult airway, although its specificity is low.

Maintenance of patent airway is essential for adequate oxygenation and ventilation. Failure, even for a short period can be life-threatening. So expertise in airway management is essential in every medical speciality. Management of the airway has come a long way since the endotracheal intubation done by Macewan (1880) to present day use of modern and sophisticated devices. The wide variety of airway armamentarium is available today. Since, time available to secure airway is short one has to be optimally prepared with proper selection of equipment, technique and participation of personnel experienced in doing it. This is a brief review of evolution of airway devices.

No abstract