Anesth Analg 2002;94:1371
© 2002 International Anesthesia Research Society
LETTERS TO THE EDITOR
Mallampati Class "Zero"
Xiaoyuan Xie, MD,
Xuan Au-Truong, MD,
Arthur J. Klowden, MD,
Ninos J. Joseph, BS, and
M. Ramez Salem, MD
Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL
To the Editor: The modified Mallampati classification is used for preoperative airway assessment (1,2). We present a patient with a Mallampati Class I airway and a visible epiglottis on mouth opening. A 44-yr-old ASA physical status I woman was scheduled for laparoscopic cholecystectomy. The patient’s preoperative airway assessment revealed a visible epiglottis in either the sitting or supine position (Figure 1). The patient’s trachea was intubated on the second attempt, as the first attempt resulted in an esophageal placement of the tube.
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Figure 1. This patient’s preoperative airway assessment revealed a visible epiglottis in either the sitting or supine position.
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A visible epiglottis in awake patients has been studied (3–6). Its incidence has recently been estimated at 1.18% by Ezri et al. (6). We agree with Ezri et al. (4,6) that a new Class Zero should be added to the existing scoring system. We also agree that a visible epiglottis on mouth opening should predict an easy tracheal intubation. The difficulty encountered in our case might have been related to a hasty introduction of the laryngoscope blade bypassing the laryngeal opening and could have been avoided by a gradual introduction of the blade.
References
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Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–34.[Web of Science][Medline]
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Samsoon GLT, Young JRB. Difficult intubation: a retrospective study. Anaesthesia 1987; 42: 487–90.[Web of Science][Medline]
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Tobold A. Lehrbuch der Laryngoskopie. 2nd ed. Berlin: Hirschwald, 1869: 42–44.
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Ezri T, Cohen I, Geva D, Szmuck P. Pharyngoscopic views [letter]. Anesth Analg 1998; 87: 748.
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Maleck WH, Koetter KK, Less SD. Pharyngoscopic views [letter]. Anesth Analg 1999; 89: 256–7.[Free Full Text]
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Ezri T, Warters RD, Szmuk P, et al. The incidence of class "zero" airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade. Anesth Analg 2001; 93: 1073–5.[Abstract/Free Full Text]
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