Mallampati class changes during pregnancy, labour, and after delivery: can these be predicted?

Boutonnet, Mathieu; Faitot, Valentina; Katz, Ariel; Salomon, L. J.; Keïta, H.

doi:10.1093/bja/aep356

Cited by 106 publications

(68 citation statements)

References 12 publications

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“…MMT is also influenced by the patient's ethnic group: tracheal intubation may be more difficult in Asian than Caucasian patients 14 . The incidence of modified Mallampati Classes 3 and 4 also increases during labor compared with the pre-labor period 15 , and these changes are not fully reversed within 48 hours after delivery 16 . Our study has several limitations that are primarily due to logistic conditions.…”

Section: Discussionmentioning

confidence: 99%

Mallampati Test as a Predictor of Laryngoscopic View

Adamus

Fritscherova²,

Hrabálek³

et al. 2010

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim.To determine the accuracy of the modified Mallampati test for predicting difficult tracheal intubation. Design. A cross-sectional, clinical, observational, non-blinded study. A quality analysis of anesthetic care. Setting. Operating theatres and department of anesthesiology in a university hospital. Material and methods. Following the local ethics committee approval and patients' informed consent to anesthesia, all adult patients (> 18 yrs) presenting for any type of non-emergency surgical procedures under general anesthesia requiring endotracheal intubation were enrolled. Prior to anesthesia, Samsoon and Young's modification of the Mallampati test (modified Mallampati test) was performed. Following induction, the anesthesiologist described the laryngoscopic view using the Cormack-Lehane scale. Classes 3 or 4 of the modified Mallampati test were considered a predictor of difficult intubation. Grades 3 or 4 of the Cormack-Lehane classification of the laryngoscopic view were defined as impaired glottic exposure. The sensitivity, specificity, positive and negative predictive value, relative risk, likelihood ratio and accuracy of the modified Mallampati test were calculated on 2x2 contingency tables.Results. Of the total 1,518 patients enrolled, 48 had difficult intubation (3.2%). We failed to detect as many as 35.4% patients in whom glottis exposure during direct laryngoscopy was inadequate (sensitivity 0.646). Conclusion. When used as a single examination, the modified Mallampati test is of limited value in predicting difficult intubation.

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Section: Discussionmentioning

confidence: 99%

Mallampati Test as a Predictor of Laryngoscopic View

Adamus

Fritscherova²,

Hrabálek³

et al. 2010

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Diffi cult airway is one of the major concerns when general anesthesia was given for cesarean section because of the following two reasons: fi rst, pregnancy-induced fi broelastic edema results in a signifi cant reduction in the space of oral and cavum larynges 9 ; second, movement limitation of cervical spine results from pregnancy obesity 23 . These factors lead to an increase in the incidence of Mallampati classes 3 and 4 9 .…”

Section: Discussionmentioning

confidence: 99%

“…These factors lead to an increase in the incidence of Mallampati classes 3 and 4 9 . In addition to these factors, our patient had a severely limited mouth opening and displaced upper trachea that undoubtedly increases the diffi culty of airway management during general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Although accidental spinal hematoma is a potential risk for these patients 4 , it is still recommended for those with moderate but not progressive thrombocytopenia [5][6][7] . Successful performance of general anesthesia with remifentanil in these patients was reported 8 , while special attention is needed because a potential risk of diffi cult airway would be encountered during anesthesia induction from the relatively narrowed oral space in pregnant women that results from fi broelastic edema 9 . Successful anesthesia depends on balancing the benefi ts and risks for choosing the anesthesia technique and performing obstetric therapeutic strategies.…”

Section: Introductionmentioning

confidence: 96%

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Pesando riscos e benefícios: lições aprendidas com as intervenções terapêuticas de um caso com pré-eclâmpsia grave

Xu¹,

Shen²,

Fuzhou³

2013

Rev. Bras. Anestesiol.

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Background and objective: Preeclampsia is a multiple organ dysfunction syndrome (MODS) for its typical and atypical manifestations including hypertension, proteinuria, HELLP syndrome, hypertensive encephalopathy and coagulopathy. Optimal management for such patients is determined from an assessment of the balance between benefi ts and risks of anesthetic and obstetric therapeutic strategies. Case Report: A 35-year-old pregnant woman, with one past uncomplicated pregnancy presented at 29 weeks to our medical institute as an emergency with dizziness, chest distress, palpitation, blurred vision and vaginal bleeding. After physical examination and laboratory tests, the patient was diagnosed with severe preeclampsia, HELLP syndrome, placental abruption, and MODS. The patient also presented spinal and pelvic deformity, fi xation of articulus mandibularis, and tracheal displacement because of a traffi c accident 11 years ago. Therefore, urgent cesarean section was performed under general anesthesia with nasal tracheal intubation using a guide wire. The patient was discharged directly home from the obstetric intensive care unit on the 7 th postoperative day with normal blood pressure and full recovery of organic function. Conclusions: This case merits further discussion on the anesthesia considerations concerning how to make a clinical decision when treating such a patient. Neuraxial block is the fi rst choice for preeclampsia patients undergoing cesarean section when a moderate but not progressive thrombocytopenia exists. When general anesthesia is decided, adequate sedation and analgesia is needed to better control the stress response to intubation especially in patients with neurological signs, and to prevent major cerebral complications.

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“…However, the odds ratio for difficult intubation for Mallampati III or IV scores is 5.89 (95% confidence interval (CI), 4.74-7.32) 18 . The Mallampati classification has been shown to change during pregnancy and to advance by one or two classes due to changes in pregnancy 19 . It is obvious that none of the tests mentioned above is specific for prediction of difficult airway.…”

Section: Preoperative Assessment Of Pregnant Patient Undergoing Cesarmentioning

confidence: 99%

Challenges of Obstetric Anesthesia: Difficult Laryngeal Visualization

Alanoğlu

Erkoç

Güçlü

et al. 2016

ACC

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SUMMARY -Obstetric anesthesia is one of the high risk subspecialties of anesthesia practice. Anesthesia related complications are the sixth leading cause of maternal mortality. Difficult or failed intubation following induction of general anesthesia for CS remains the major contributory factor to anesthesia-related maternal complications. The airway management of obstetric patients is a challenging issue for several reasons. Anatomic and physiologic changes related to pregnancy may increase the difficult and failed intubation rates compared to the general surgical population. Proper evaluation of the airway anatomy and airway structures is vital to prevent airway management related catastrophes. In addition to basic airway and intubation equipment, each anesthesia department must have difficult intubation equipment cart including fiber optic laryngoscope, video laryngoscopes, and different types of laryngeal masks. It is essential that all anesthesiologists have a preconceived and well thought-out algorithm and emergency airway equipment to deal with airway emergencies during difficult or failed intubation of a parturient.

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Mallampati class changes during pregnancy, labour, and after delivery: can these be predicted?

Abstract: The incidence of Mallampati classes 3 and 4 increases during labour compared with the pre-labour period, and these changes are not fully reversed by 48 h after delivery. This work confirms the absolute necessity of examining the airway before anaesthetic management in obstetric patients.

Cited by 106 publications

References 12 publications

Mallampati Test as a Predictor of Laryngoscopic View

Mallampati Test as a Predictor of Laryngoscopic View

Pesando riscos e benefícios: lições aprendidas com as intervenções terapêuticas de um caso com pré-eclâmpsia grave

Challenges of Obstetric Anesthesia: Difficult Laryngeal Visualization

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