TO EVALUATE THE CHANGE OF MALLAMPATI SCORE WITH INSPIRATION AND EXPIRATION: AN OBSERVATIONAL STUDY

FOR MALLAMPATI SCORE:

· Keeping the patients tongue protruded ,patients will be instructed to inhale and hold their breath, and inspiration Mallampati score will be obtained.

· Then in the same view, patients will be instructed to exhale and expiration Mallampati score will be  obtained

· The documented Mallampati score with the respiration will be  compared with the baseline Mallampati score documented by the anesthesia team in pac clinic

· Scoring will be  partitioned into 7 categories[8]:

§ WORSE : [ -3,-2,-1]

§ SAME     : [ 0 ]

§ BETTER: [1,2,3]

· For example: If a patients reference Mallampati score was 2, but it was 3 during inspiration , we would score that change as -1.

FOR TMD WITH RESPIRATION:

· Patient will be instructed to extend hisher neck to maximum with the mouth closed .

· And the patient will be  instructed to inhale and hold and the measurement is documented and patient will be instructed to exhale and measurement is documented.

FOR SMD WITH RESPIRATION:

Sternomental distance is measured as they’re mental distance is measured and measurement is document

REFERENCES

1. Hanouz JL, Bonnet V, Buléon C, et al. Comparison of the Mallampati classification in sitting and supine position to predict difficult tracheal intubation: a prospective observational cohort study. Anesthesia & Analgesia *.*2018;126(1):161–9.

2.  Manabe Y, Iwamoto S, Miyawaki H, Seo K, Sugiyama K. Mallampati classification without tongue protrusion can predict difficult tracheal intubation more accurately than the traditional Mallampati classification. Oral Science International . 2014;11(2):52–5.

3. Tham EJ, Gildersleve CD, Sanders LD, Mapleson WW, Vaughan RS. Effects of posture, phonation and observer on mallampati classification. British Journal of Anaesthesia *.*1992;68(1):32–8.

4.  Nuckton TJ, Glidden DV, Browner WS, Claman DM. Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep . 2006;29(7):903–8.

5.   Osman AM, Carberry JC, Gandevia SC, Butler JE, Eckert D J. Changes in pharyngeal collapsibility and genioglossus reflex responses to negative pressure during the respiratory cycle in obstructive sleep apnoea. The Journal of Physiology*.*2020;598(3):567–80.

6. Osman AM, Carberry JC, Gandevia S C, Butler J E, Eckert D J. Changes in pharyngeal collapsibility and genioglossus reflex responses to negative pressure during the respiratory cycle in obstructive sleep apnoea. The Journal of Physiology *.*2020;598(3):567–80.

7. Lee A, Fan LTN, Gin T, Karmakar MK, Ngan Kee W D. A systematic review (Meta-Analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesthesia and Analgesia *.*2006;102(6):1867–78.

8.  Naftalovich R, Oydanich M, Adeola J, Eloy JD, Rodriguez-Correa D, Tewfik GL. A Prospective Cohort Study on the Respiratory Effect on Modified Mallampati Scoring. Anesthesiol Res Pract. 2023 Aug 23;2023:2193403