Der Mallampati-ScoreVorhersage der schwierigen Intubation in der HNO-Laserchirurgie mittels Mallampati-Score

Zusammenfassung

Der Mallampati-Score ist eine gebräuchliche Methode zur Vorhersage der schwierigen Intubation. Wir testeten seine Validität in der HNO-Laserchirurgie.

Methoden: Bei 91 Patienten, die sich einem geplanten laserchirurgischen Eingriff in der HNO unterziehen mußten, wurde unmittelbar vor der Narkoseeinleitung der Mallampati-Score in der Modification nach Samsoon u. Young [18] ermittelt. Nach Narkoseeinleitung wurde die laryngoskopische Sicht nach Cormack u. Lehane [5] beurteilt. Es wurde untersucht, inwieweit ein Mallampati-Score ≥3 eine schwierige Intubation (d.h. einen Cormack u. Lehane-Grad ≥3) vorhersagt.

Ergebnisse: 62 Patienten hatten einen Mallampati-Score ≤2. Von diesen hatten 4 (=6%) einen Cormack u. Lehane-Grad ≥3.

29 Patienten hatten einen Mallampati-Score ≥3. Von diesen hatten 6 (=21%) einen Cormack u. Lehane-Grad ≥3.

Schlußfolgerung: Dieser Unterschied war signifikant im χ²-Test (p<0,05). Patienten mit einem Mallampati-Score ≥3 waren also signifikant häufiger schwierig zu intubieren. Niedrige Sensitivität (60%) und Spezifität (72%) begrenzen jedoch den praktischen Wert des Tests.

Abstract

The Mallampati score (MS), later modified by Samsoon and Young, is a common method used to predict difficult intubation. We tested its predictive value in otolaryngologic (ENT) laser surgery.

Methods: Ninety-one patients scheduled for elective ENT laser surgery had the modified MS noted prior to induction in the supine position, with the tongue fully protruded and phonating ”ah”; 22 patients were female, 69 male. The mean age was 54±15 (6–84) years, height 171±9 (130–190) cm, and weight 72±21 (20–99) kg. After a standard induction, the laryngoscopic view was graded according to Cormack and Lehane (C&L). An intubation was considered difficult if the C&L score was ≥3, i.e., no part of the glottis seen during laryngoscopy. The hypothesis tested was that a MS ≥3 (i.e., only the base of the uvula or nine of the uvula was seen) is predictive of difficult intubation in this group of patients. This chi-square test was used for calculation of significance.

Results: All intubations were performed in less than three attempts, and no C&L score of 4 (i.e., not even the epiglottis seen during laryngoscopy) was observed; 10 patients had a C & L score ≥3, i.e., a difficult intubation according to our definition. Sixty-two patients had a MS ≤2; of these, 4 (=6%) were difficult to intubate. Twenty-nine patients had MS ≥3; of these, 6 (=21%) were difficult to intubate. This difference was significant (chi-square=4.1, P<0,05).

Conclusion: Difficult intubation was significantly more common in patients with MS ≥3. Low sensitivity (60%) and specificity (72%) limit the clinical value of this test, however.