Introduction Unanticipated difficult laryngoscopic intubation has been a major concern for anaesthesiologist in pediatric patients. Failure to maintain the patency of airway after induction of anesthesia can lead to catastrophic sequalae such as hypoxemia, irreversible brain damage and death. There are important anatomical and physiological differences that occur during development which requires a different approach and technique. We designed this study to compare the effect of phonation on the Mallampati test in upright and supine position against the traditionally employed test without phonation in serving to predict difficult laryngoscopy and intubation in paediatric age group. Aims and Objectives are To evaluate the effect of phonation on Mallampati test in supine and upright position and correlation of it with laryngoscopic view using Cormack and Lehane score and difficulty in endotracheal intubation. Material and methods In this prospective study, 100 patients aged 3-12 years were recruited. The Mallampati test was conducted on patients with and without phonation in upright and supine position. A blind trained observer then performed laryngoscopy and intubation. Difficult intubation was assessed according to the Cormack-Lehane Grading scale and intubation difficulty score. Diagnostic statistical measures were calculated: sensitivity, specificity, positive and negative predictive values. Results In this study, the ROC curve analysis found Mallampati test in upright without phonation (AUC=959, Z=5.68, p<0.001) is the most significant in predicting difficult laryngoscopy compared to other positions. In upright without phonation, the sensitivity and specificity of Mallampati test and laryngoscopy was the highest compared with phonation. In upright without phonation group sensitivity and specificity for difficulty laryngoscopy were 71.43% and 94.62% respectively. Sensitivity and specificity for difficulty intubation were 80%, 93.68% respectively in this position. In upright with phonation, sensitivity and specificity for difficulty laryngoscopy were 28.57% and 98.92% respectively. Sensitivity and specificity for difficulty intubation were 40%, 98.95% respectively in this position. In supine without phonation group, sensitivity and specificity for difficulty laryngoscopy were 85.71% and 78.49% respectively. Sensitivity and specificity for difficulty intubation were 80%, 76.84% respectively in this position. In supine with phonation group, sensitivity and specificity for difficulty laryngoscopy were 57.14% and 94.62% respectively. Sensitivity and specificity for difficulty intubation were 60%, 93.68% respectively in this position. Conclusions Evaluation of airway in supine position without phonation with Modified Mallampati test is equally good alternative to upright (sitting) position without phonation for predicting difficult airway in bedridden patients and in emergency cases.
