Üst dudak ısırma testi ile zor havayolu testlerinin karşılaştırılması
Date
2009
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Genel anestezi öncesi intübasyon zorluğunu değerlendirmede 2003 yılnda tanımlanan Üst Dudak Isırma testinin etkinliğini, sık kullanılan zor intübasyon testleri olan Mallampati Sınıflandırması ile Wilson Risk Skoru testlerini karşılaştırmayı amaçladık.Çalışmamıza genel anestezi altında endotrakeal intübasyon yapılacak,18-68 yaş arası, toplam 105 olgu çalışmaya alındı. Hastalara genel anestezi öncesi testler uygulandı. Tüm hastalara standart genel anestezi indüksiyon uygulandı ve intübasyon sırasında Cormack-Lehane ile laringoskopik görünüm skorlandı.Olgularda Cormack-Lehane sınıflamasına göre zor intübasyon insidansı %4.8 olarak bulundu. Testlerin zor intübasyonu belirlemedeki başarıları karşılaştırıldığında en yüksek duyarlılığa sahip test %89.6 oranı ile Wilson Risk Skoru, özgüllüğü en yüksek test %97 değeri ile Üst Dudak Isırma testi, Wilson Risk skoru ise %77 değeri ile özgüllügü en düşük test olarak bulundu. En yüksek positif belirleyici değerine sahip test %50 ile Üst Dudak Isırma testi olarak saptandı. Yalancı pozitiflik oranı değerleri Üst Dudak Isırma testi için %3, Mallampati sınıflandırması için %6 olarak bulundu. Wilson Risk skoru ise %23 değeri ile en yüksek yalancı pozitiflik oranına sahip test olarak saptandı. Yalancı negatiflik oranı incelendiğinde Üst Dudak Isırma testi ve Wilson Risk skoru için %40, Mallampati sınıflandırması için %60 olarak bulundu.Zor intübasyonu belirlemede kullanılan testlerin tek başlarına yeterli düzeyde duyarlılık, yalancı negatiflik değeri ve pozitif belirleyicilik değerlerine sahip olmadığı bulunmuştur.Üst dudak ısırma testinin pratik olması ve sonuçlarının Mallampati sınıflandırmasının sonuçları ile paralellik göstermesi üst dudak ısırma testinin yararlılığını göstermektedir. Testlerin birlikte kullanımı ile daha güçlü sonuçlar alınabileceğini düşünmekteyiz.
In this study we aim to compare the effectiveness of the Upper Lip Bite test, a method developed year 2003 for evaluating the difficulty of intubation before administring general anesthesia, with the two commonly used intubation difficulty tests of Mallampati Classification and Wilson Risk Scoring.A total of 105 patients, aged between 18 and 68, who were to be performed endotracheal intubation were enrolled in the study. Tests were performed on the patients prior to their general anesthesia. The standard general anesthesia induction was performed on each patient and the Cormack-Lehane and laringoscopic imaging scores were recorded during their intubation.The difficult intubation rate was found as 4.8% according to Cormak-Lehane test. When sucsess rate of difficult intubation determinig of the test were compared, the most sensitive test was found as Wilson Risk Score with the rate of 89.6%, Upper Lip Bite Test was found as the most specific test with the rate of 97%, Wilson Risk Score was found as the worst specific test with the rate of 77%, Upper Lip Bite Test?s positive predictive value was found as the best among three teast with the rate of 50%. Negative predictive values were found 3% for Upper Lip Bite Test and 6% for Mallampati Score. Negative predictive value of Wilson Risk Score was the highest with the rate of 23% among three tests. False negative values of tests were 40% for Upper Lip Bite and Wilson Risk Score and 60% for Mallampati Scoring tests.It is found that any none of the tests being used for predicting difficult intubation does not have satisfactory values of sensitivity, false negativity, and positive predictive value. The practicality of the Upper Lip Bite Test andthe similarity of its results with the Mallampati Score shows the utility of the Upper Lip Bite Test. We think that stronger results can be obtained by the use of multiple tests together.
In this study we aim to compare the effectiveness of the Upper Lip Bite test, a method developed year 2003 for evaluating the difficulty of intubation before administring general anesthesia, with the two commonly used intubation difficulty tests of Mallampati Classification and Wilson Risk Scoring.A total of 105 patients, aged between 18 and 68, who were to be performed endotracheal intubation were enrolled in the study. Tests were performed on the patients prior to their general anesthesia. The standard general anesthesia induction was performed on each patient and the Cormack-Lehane and laringoscopic imaging scores were recorded during their intubation.The difficult intubation rate was found as 4.8% according to Cormak-Lehane test. When sucsess rate of difficult intubation determinig of the test were compared, the most sensitive test was found as Wilson Risk Score with the rate of 89.6%, Upper Lip Bite Test was found as the most specific test with the rate of 97%, Wilson Risk Score was found as the worst specific test with the rate of 77%, Upper Lip Bite Test?s positive predictive value was found as the best among three teast with the rate of 50%. Negative predictive values were found 3% for Upper Lip Bite Test and 6% for Mallampati Score. Negative predictive value of Wilson Risk Score was the highest with the rate of 23% among three tests. False negative values of tests were 40% for Upper Lip Bite and Wilson Risk Score and 60% for Mallampati Scoring tests.It is found that any none of the tests being used for predicting difficult intubation does not have satisfactory values of sensitivity, false negativity, and positive predictive value. The practicality of the Upper Lip Bite Test andthe similarity of its results with the Mallampati Score shows the utility of the Upper Lip Bite Test. We think that stronger results can be obtained by the use of multiple tests together.
Description
Keywords
Zor intübasyon, Üst dudak ısırma testi, Mallampati sınıflandırması, Wilson risk skoru, Difficult intubation, Upper lip bite test, Mallampati score, Wilson risk score
Citation
Korkmaz, S. (2009). Üst dudak ısırma testi ile zor havayolu testlerinin karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.