Rashmee V Chavan

Abstract

Introduction: No anaesthesiologist like to face scenario of unanticipated difficult intubation, as it may cost patients life. Many tests are there to predict difficult intubation, amongst those tests Modified Mallampati test [MMT] is a gold standard test. Upper lip bite test [ULBT] is an acceptable option for predicting difficult intubation. Our study aimed to compare both the tests to predict difficult intubation. Objectives: To analyse positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and accuracy of ULBT and MMT. To compare the results of both the tests to predict difficult intubation. Aim: To ascertain whether ULBT can be incorporated in standard protocol of airway assessment along with other tests to increase predictive accuracy of difficult endotracheal intubation Materials and Methods: It was prospective randomised comparative observational study carried out at single centre. Three hundred patients of either sex, aged between 16-60 yrs scheduled for elective surgery under general anaesthesia with endotracheal intubation were enrolled in the study. Preoperative evaluation of airway was done with ULBT and MMT and findings were documented.MMT class III,IV and ULBT class III were considered as predictors of difficult intubation. On the day of the surgery after direct laryngoscopy laryngeal view was noted and was classified according to Cormack and Lehane classification. Patients with Cormack Lehane class III,IV considered as difficult to intubate. Cormack Lehane classification (C &L class) redings were compared with ULBT and MMT. Observations and Results: Demographic data and ASA grade was same for both the groups as participants were same. By comparing ULBT with Cormack and Lehane score we got 88.46% sensitivity, 92.74% specificity, 71.87% Positive predictive value (PPV), 97.45% ne gative predictive value (NPV) and 92% accuracy. For MMT we go t 19.23% sensitivity, 91.93% specificity, 33.33% PPV, 84.44% NPV a nd 79.33% accuracy. Thus results showed accuracy, sensi tivity, PPV and NPV of ULBT were superior than MMT while specificity of both the tests was similar. Conclusion: With higher level of sensitivity, PPV, NPV and accuracy ULBT is a better choice for predicting difficult airway than that of MMT. ULBT should be incorporated in standard airway assessment protocol along with other tests. Keywords: Difficult intubation, modified Mallampati test, Upper lip bite test, Cormack lehane classification.

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Abstract

Introduction: Sciatic nerve block (SNB) is an established technique of anaesthesia for lower limb and foot surgeries. Although several approaches to SNB have been described not a single one is ideal in all respect. We aimed to compare commonly used two approaches to SNB to fin d out which one is better with regard to efficacy and patient satisfaction. Materials and Methods: Consented 60 diabetic patients of ASA grade II,III posted for foot and /or lower limb surgery were randomly allocated to receive SNB by either anterior (n=30) or posterior (n=30) approach. Blocks were performed utilizing peripheral nerve stimulator (PNS), with 25 ml of local anaesthetic mixture (10 ml of 2% lignocaine with adrenaline and 15 ml of 0.5% bupivacaine). Time taken to perform block with number of attempts required, onset of sensory and motor block, duration of analgesia were record ed and compared. We also had compared comfort level of the patients. Observations and Results: Out of 60 patients, 1of anterior and 2 of posterior approach es had failed block. Time taken to perform anterior approach was significantly less (p< 0> approach. Patients were comfortable with anterior approach than that of posterior. Faster onset of sensory and motor block, and more duration of analgesia was observed with the posterior group but the difference was not statistically significant. Conclusion: Our study concluded that though efficacy of both the anterior and posterior approaches to block sciatic nerve was same, anterior approach is easier than posterior approach as it requires lesser time to perform and gives far better patient comfort. Keywords: Anterior sciatic nerve block, Diabetic foot surgery.

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