Original Article

CME Article: Airway Assessment of Patients Undergoing Endoscopic Procedures

Authors: Kristi T. Lopez, MD, Shoba Theivanayagam, MD, Akwi W. Asombang, MD, Michelle L. Matteson-Kome, PhD, Matthew L. Bechtold, MD

Abstract

Objectives: In advance of endoscopic procedures, an evaluation to assess the risk of sedation is performed by the gastroenterologist. Based on regulations, gastroenterologists are required to perform an airway assessment. At this time, data supporting this regulation are limited; therefore, we evaluated airway assessment accuracy by gastroenterologists before endoscopic procedures.

Methods: A retrospective, single tertiary care center study was performed from May 2012 through August 2013. Patients who underwent an endoscopy or colonoscopy performed at the University of Missouri–Columbia with documented Mallampati scores were included in the analysis. Three primary cohorts of patients were included in our study: gastroenterologist versus anesthesiologist, gastroenterologist versus other gastroenterologists, and gastroenterologists versus themselves. Data were collected and recorded for patient age, body mass index, and Mallampati score. Statistical analysis was performed using descriptive statistics and linear weighted kappa analysis for agreement.

Results: For gastroenterologists versus anesthesiologists and versus other gastroenterologists, the agreement on Mallampati scores was poor (weighted kappa index 0.103, 95% confidence interval [CI] −0.0126 to 0.219; percentage of agreement 42% and 0.120, 95% CI −0.0211 to 0.260; percentage of agreement 46%, respectively). For gastroenterologists versus themselves for the same patient, the agreement on Mallampati scores was only moderate (weighted kappa index 0.420, 95% CI 0.119–0.722; percentage of agreement 65%).

Conclusions: Gastroenterologists performing a preprocedure assessment using Mallampati scores have poor agreement with anesthesiologists and colleagues and only moderate agreement with themselves.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy, Lichtenstein DR, Jagannath S, et al. Sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2008;68:815-826.
 
2. American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association Institute, et al. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastrointest Endosc 2012;76:e1-e25.
 
3. Peterson GN, Domino KB, Caplan RA, et al. Management of the difficult airway: a closed claims analysis. Anesthesiology 2005;103:33-39.
 
4. Hove LD, Steinmetz J, Christoffersen JK, et al. Analysis of deaths related to anesthesia in the period 1996Y2004 from closed claims registered by the Danish Patient Insurance Association. Anesthesiology 2007;106:675-680.
 
5. Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985;32:429-434.
 
6. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987;42:487-490.
 
7. Connor CW, Segal S. The importance of subjective facial appearance on the ability of anesthesiologists to predict difficult intubation. Anesth Analg 2014;118:419-427.
 
8. Khan MN, Rabbani MZ, Qureshi R, et al. The predictors of difficult tracheal intubations in patients undergoing thyroid surgery for euthyroid goiter. J Pak Med Assoc 2010;60:736-738.
 
9. Kim WH, Ahn HJ, Lee CJ, et al. Neck circumference to thyromental distance ratio: a new predictor of difficult intubation in obese patients. Br J Anaesth 2011;106:743-748.
 
10. Khan ZH, Mohammadi M, Rasouli MR, et al. The diagnostic value of the upper lip bite test combined with sternomental distance, thyromental distance, and interincisor distance for prediction of easy laryngoscopy and intubation: a prospective study. Anesth Analg 2009;109:822-824.
 
11. Lundstrøm LH, Møller AM, Rosenstock C, et al. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database. Anesthesiology 2009;110:266-27.
 
12. Mashour GA, Kheterpal S, Vanaharam V, et al. The extended Mallampati score and a diagnosis of diabetes mellitus are predictors of difficult laryngoscopy in the morbidly obese. Anesth Analg 2008;107:1919-1923.
 
13. Gonzalez H, Minville V, Delanoue K, et al. The importance of increased neck circumference to intubation difficulties in obese patients. Anesth Analg 2008;106:1132-1136.
 
14. Eberhart LH, Arndt C, Cierpka T, et al. The reliability and validity of the upper lip bite test compared with the Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation. Anesth Analg 2005;101:284-289.
 
15. Khan ZH, Kashfi A, Ebrahimkhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg 2003;96:595-599.
 
16. Rosenstock C, Gillesberg I, Gatke MR, et al. Inter-observer agreement of tests used for prediction of difficult laryngoscopy/tracheal intubation. Acta Anaesthesiol Scand 2005;49:1057-1062.
 
17. Karkouti K, Rose DK, Ferris LE, et al. Inter-observer reliability of ten tests used for predicting difficult tracheal intubation. Can J Anaesth 1996;43: 554-559.
 
18. Lee A, Fan LT, Gin T, et al. A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg 2006;102:1867-1878.
 
19. Lundstrøm LH, Vester-Andersen M, Møller AM, et al. Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177088 patients. Br J Anaesth 2011;107:659-667.
 
20. Huang HH, Lee MS, Shih YL, et al. Modified Mallampati classification as a clinical predictor of peroral esophagogastroduodenoscopy tolerance. BMC Gastroenterol 2011;11:12.