A COMPARATIVE ANALYSIS OF MALLAMPATI GRADING IN SITTING AND SUPINE POSITIONS FOR DIFFICULT INTUBATION

Abstract

Background: The Mallampati grading (MPG) system is commonly used to predict difficult intubation and is traditionally assessed in the sitting position, whereas intubation is usually performed in the supine position. Objective: To compare the diagnostic accuracy of Mallampati grading in sitting and supine positions, correlate findings with Cormack-Lehane laryngoscopic grades, and evaluate the applicability of supine assessment in predicting difficult airway. Methods: This prospective observational study included 100 patients undergoing elective surgery requiring endotracheal intubation. Mallampati grading was performed preoperatively in both sitting and supine positions. Intubation was carried out by an experienced anaesthesiologist blinded to the Mallampati scores. Difficult intubation was assessed using the Cormack-Lehane classification. Results: Mallampati grades were generally higher in the supine position, suggesting increased detection of difficult airway. A significant correlation was observed between Mallampati grading and Cormack-Lehane grade in both positions (p<0.001). The predictive accuracy, based on the area under the ROC curve, was higher in the supine position compared to the sitting position. Higher supine Mallampati grades were associated with a significantly increased risk of difficult intubation. Conclusion: Mallampati grading in the supine position demonstrates superior predictive accuracy compared to the sitting position. Incorporating supine assessment into routine preoperative airway evaluation may improve the prediction of difficult intubation and enhance patient safety.