Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation?

Green, Steven M.; Roback, Mark G.

doi:10.1016/j.annemergmed.2018.12.021

Cited by 29 publications

(17 citation statements)

References 56 publications

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“…The Mallampati score, a classical measure of pre-anesthesia assessment, did not differ signi cantly in the AE and non-AE groups. This nding was in agreement with studies showing that Mallampati score did not signi cantly predict the occurrence of AEs in pediatric patients undergoing sedation [29,30].…”

Section: Discussionsupporting

confidence: 91%

“…Mallampati score, however, is di cult to assess objectively, as independent observers commonly grade these scores differently [30], with its reliability being especially low in patients aged <3 years [31]. The median (IQR) age of patients in the present study was 2.7 (11.1-4.8) years, suggesting a lower association between Mallampati score and AEs.…”

Section: Discussionmentioning

confidence: 56%

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Safety and Efficacy of Pediatric Sedation Protocols for Painless Diagnostic Examination in A Pediatric Emergency Room of A Single Tertiary Hospital

Park

Byun

Lee

et al. 2020

Preprint

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Background: Pediatric patients undergoing diagnostic tests in the pediatric emergency room are frequently sedated. Although efforts are made to prevent adverse events, no sedation protocol has specified the optimal regimen, dosage, and interval of medication to prevent adverse events. This study analyzed the safety and efficacy of sequential pediatric sedation protocols for pediatric patients undergoing diagnostic tests in the pediatric emergency room of a single tertiary medical center.Methods: The medical records of patients aged <18 years who visited the pediatric emergency room of Seoul Asan Medical Center between January and December 2019 for diagnostic testing were retrospectively reviewed. Sedation protocols consisted of 50 and 25 mg/kg chloral hydrate, 0.1 and 0.1 mg/kg midazolam, and 1 and 0.5–1 mg/kg ketamine, administered sequentially at intervals of 30, 20, 10, 10, and 10 min, respectively. Patients were assessed prior to sedation, and adverse events were investigated.Results: Of the 289 included patients, 20 (6.9%) experienced adverse events, none serious, and nine (3.1%) failed to reach the depth of sedation required to complete the test. The regimen (P=0.622) and dosage (P=0.777) of the sedatives were unrelated to the occurrence of adverse events when sedation was performed according to protocol.Conclusion: The sedation protocol used in these patients, consisting of sequential administration of minimum dosages, achieved a sufficient depth of sedation with relatively few adverse events, indicating that this protocol can be used safely and effectively for painless sedation in pediatric patients undergoing diagnostic testing.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 56%

Safety and Efficacy of Pediatric Sedation Protocols for Painless Diagnostic Examination in A Pediatric Emergency Room of A Single Tertiary Hospital

Park

Byun

Lee

et al. 2020

Preprint

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“…A classic example described in the literature is the Mallampati classification, which assigns a score from I to IV. Type I have less and type IV has greater difficulty in intubation based on the visualization of anatomical structures [8]. The patient had Mallampati III.…”

Section: Discussionmentioning

confidence: 90%

Dentoalveolar trauma induced by intubation in urgent maxillofacial surgery: case report

Andrade¹,

Pontes²,

ARAÚJO³

et al. 2022

RGO, Rev. Gaúch. Odontol.

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Dental trauma is a common complication in general anesthesia, especially when using nasotracheal intubation during the classic laryngoscopy. Risk factors range from difficult intubation through difficult airways to occlusal changes in the patient, with incisors being widely affected by dental elements. Tooth avulsion is the most frequent type of trauma, followed by lateral dislocation and root fracture. Male patient, 39 years old, presented at the Emergency and Trauma Hospital in Caruaru/PE, a motorcycle accident victim with a bilateral jaw fracture. Given the need to fix fractures, the patient underwent a surgical procedure under general anesthesia. During laryngoscopy, heavy bleeding was observed in the oral cavity. After inspection, root fracture of lateral incisor and avulsion of right central incisor were noted. The avulsionated tooth was not found. An orthopedic image intensifier was used to locate the dental element in the thoracic region. However, it was not possible to determine its location. Therefore, an upper gastrointestinal (UGI) endoscopy was requested, and the dental element was in the digestive tract at the esophagus level. The tooth was removed, and the surgical procedure for osteosynthesis of bilateral mandible fracture was carried on. Dentoalveolar traumas induced by general anesthesia are frequent and require preventive measures since they can directly affect the patient’s physical, economic, and medical conditions, along with anesthesiologists and maxillofacial surgeon’s risk of receiving a civil lawsuit.

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“…The Mallampati's score lacks the accuracy, reliability, and feasibility required to supplement a standard airway evaluation. 17…”

Section: Discussionmentioning

confidence: 99%

“…It cannot be evaluated in many young children and in patients who cannot cooperate because of their underlying medical condition. The Mallampati's score lacks the accuracy, reliability, and feasibility required to supplement a standard airway evaluation 17.…”

mentioning

confidence: 99%

Perioperative Assessment of Difficult Airway Using Ultrasound—A Prospective Study

Ankad

Manjunatha

Hiremath

et al. 2022

IJRSMS

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Background The study was conducted with the aim of determining the usefulness of ultrasonography in assessment of difficult airway preoperatively to compare and correlate airway assessment done clinically and airway viewed ultra sonographically with Cormack–Lehane classification of the direct laryngoscopy. Methodology This prospective, observational trial consists of total 150 patients undergoing elective surgeries under general anesthesia. The measurements recorded were interincisor gap, modified Mallampati's classification, and thyromental distance and the airway assessment of ultrasound done. Based on the Cormack–Lehane classification of laryngoscopic view, patients were classified into different groups: group A—easy intubation and group B—difficult intubation, at the end of the study. Results In both the groups, demographic data were similar except weight, which was significant in group B. Ultrasound measurements of airway done at four levels—hyoid bone, suprasternal-notch, thyroid isthmus, and thyroid—were increased in group B compared with group A, with p-values 0.0002, 0.0001, 0.001, and 0.0001, respectively, showing significant results. Conclusion On the basis of our study, we conclude that by measuring the thickness of soft tissues in the anterior part of neck with ultrasound difficult airway can be predicted, thus ultrasound can be used for assessing difficult airway preoperatively.

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Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation?

Cited by 29 publications

References 56 publications

Safety and Efficacy of Pediatric Sedation Protocols for Painless Diagnostic Examination in A Pediatric Emergency Room of A Single Tertiary Hospital

Safety and Efficacy of Pediatric Sedation Protocols for Painless Diagnostic Examination in A Pediatric Emergency Room of A Single Tertiary Hospital

Dentoalveolar trauma induced by intubation in urgent maxillofacial surgery: case report

Perioperative Assessment of Difficult Airway Using Ultrasound—A Prospective Study

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