Study objective: To determine the diagnostic value of Modified Mallampati Classification versus NEMA (Neck Circumference Minus Acromion-Acromion Distance) for predicting difficult intubation among patients undergoing elective surgery requiring general anesthesia.
Design: Observational, Cross-sectional
Setting: Baguio General Hospital and Medical Center
Methodology: The study will include 139 patients admitted at Baguio General Hospital and Medical Center who will undergo nonemergency surgical interventions. All patients who will undergo general anesthesia with endotracheal intubation for elective abdominal, urological, vascular, otolaryngological (ENT) and orthopaedic surgery will be informed about the aims of the study and written consent will be obtained from each patient. The clinical airway assessment consisted of an oropharyngeal examination using Modified Mallampati classification and measurement of the neck circumference and acromion to acromion distance. Both, the Mallampati classification and NEMA will be evaluated in patients in the sitting position.
Results: In terms of sensitivity, PPV, and NPV (Table 4), NEMA measurement is better than Mallampati classification in predicting the difficulty of intubation. NEMA measurement is significantly associated with the TRUE classification of intubation (being difficult or easy). Modified Mallampati Classification is NOT significantly associated with the TRUE classification of intubation (being difficult or easy). There was a significant difference observed between NEMA measurement and Modified Mallampati Classification, NEMA measurement (P-value <.001) is significantly different to Modified Mallampati classification (P-value= <.430) at alpha .05 showing NEMA measurement is a more effective predictor for difficulty on intubation as compared to Modified Mallampati Classification.
Conclusion: NEMA was shown to be a good predictor of difficult intubation with higher sensitivity, Negative Predictive Value and Negative Predictive Value when compared with Modified Mallampati Classification.