Comparison of Mallampati test in sitting position and in supine position for prediction of difficult tracheal intubation among adult patients who underwent surgery under general anesthesia at Addis Ababa governmental hospitals 2021, comparative cross-sectional study

BACKGROUND: The Mallampati test is used to evaluate the airway to predict difficult laryngoscopy and intubation. The sitting position is the standard for this test, but it has limited practical utility due to its low sensitivity and moderate specificity in predicting difficult intubation and laryngoscopy. The supine position, on the other hand, may improve its efficacy. OBJECTIVE: To assess the Mallampati test in sitting and supine positions on predicting difficult laryngoscopy and intubation among Adult surgical patients undergoing general anesthesia in selected governmental hospitals of Addis Ababa. METHOD: A cross-sectional study was conducted on 403 adult patients who underwent surgery that required endotracheal intubation. The preoperative Mallampati test in sitting and supine positions was compared to the Cormac and Lehan grade and Intubation Difficulty Scale using the chi-square test. The Statistical Package for Social Sciences (SPSS) software version 26.0 was used to analyze the data. A p-value of less than 0.05 was used to determine statistical significance. As statistical measurements, sensitivity, specificity, positive predictive values, and negative predictive values were calculated. RESULT: The incidence of difficult laryngoscopy and intubation is 13.7% and 9.7% respectively. Supine positions show a sensitivity of 78.8%; specificity of 93%; a positive predictive value of 64.1 and a negative predictive value of 96. Whereas sitting shows sensitivity of 75%; specificity of 96.3%; positive predictive value of 76.5 and negative predictive value of 96 concerning difficult laryngoscopy. Related to difficult intubation supine shows a sensitivity of 78.4%; 89.8% specificity; 45.3 positive predictive value and 97.5 negative predictive values, whereas sitting shows 73% sensitivity, 93% specificity, 52.9% positive predictive value and 97% negative predictive value. CONCLUSION: and recommendation: For predicting difficult tracheal intubation and laryngoscopy, sitting has a high specificity and positive predictive value, but supine has high sensitivity and negative predictive value. Despite its poor positive predictive value, supine has a comparable prediction for difficult intubation therefore it can be used as an alternative approach.