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PREDIKTOR KESULITAN VISUALISASI LARING TERHADAP RAS MELAYU DI RSUPNCM : PERBANDINGAN ANTARA RASIO LINGKAR LEHER TERHADAP JARAK TIROMENTAL DENGAN SKOR MALLAMPATI DAN JARAK TIROMENTAL = DIFFICULT VISUALIZATION OF THE LARYNX IN RSUPNCM MALAY RACE: COMPARISON BETWEEN NECK CIRCUMFERENCE TO THYROMENTAL DISTANCE RATIO WITH MALLAMPATI SCORE AND THYROMENTAL DISTANCE.

Latar belakang: Skor Mallampati dan jarak tiromental (TMD) banyak digunakan sebagai prediktor kesulitan visualisasi laring preoperatif, namun akurasi kedua penanda tersebut masih dipertanyakan. Penelitian ini mengevaluasi kemampuan memprediksi kesulitan visualisasi laring (DVL) dari prediktor preoperatif baru yaitu rasio lingkar leher (NC) terhadap jarak tiromental TMD dibandingkan dengan skor Mallampati dan jarak tiromental. Metode: Sebanyak dua ratus tujuh belas pasien yang menjalani anestesia umum untuk bedah elektif dievaluasi dengan menggunakan skor Mallampati, TMD dan rasio NC/TMD. Dan titik potong untuk masing-masing prediktor jalan nafas adalah skor Mallampati III dan IV, < 6,5 cm, ≥ 5. Pada saat dilakukan laringoskopi langsung, visualisasi laring dinilai berdasarkan klasifikasi Cormack Lehane (CL). Skor CL derajat III dan IV dianggap sulit visualisasi. Kemudian ditentukan dan dibandingkan nilai area dibawah kurva (AUC), sensitifitas, spesifisitas untuk setiap prediktor jalan nafas. Hasil: Kesulitan untuk memvisualisasi laring ditemukan pada 20 (9,7%) pasien. Area dibawah curve (AUC) rasio NC/TMD (96,2%) lebih baik dibandingkan dengan skor Mallampati (64%) dan TMD (83%). Kesimpulan: Akurasi rasio NC/TMD lebih baik dibandingkan dengan skor Mallampati dan TMD.
Kata kunci: Skor Mallampati, jarak tiromental (TMD), rasio lingkar leher terhadap jarak tiromental (NC/TMD), sulit visualisasi laring


Background: Mallampati score and thyromental distance (TMC) has widely use to identify potentially difficult laringoscopies preoperative, however it’s predictive reliability is unclear. This research purpose are to evaluate the ability to predict difficult visualization of the larynx (DVL) from new preoperative airway predictors neck circumference ratio to thyromental distance (NC/TMD) compare to Mallampati score and thyromental distance.. Methods: Two hundred and seventeen consecutive patients undergoing general anesthesia for elective surgery were evaluated using the Mallampati score, TMD, NC/TMD ratio and the cut-off points for the airway predictors were Mallampati score III and IV; ≤ 6,5 cm; ≥ 5. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grade III and IV were considered difficult visualization. Area under curve (AUC), sensitivity, specificity for each airway predictors were determined and compared. Result: Difficult to visualize the larynx was found in 20 (9,7%) patients. The AUC of NC/TMD ratio (96,2%) is better tcompared to TMD (83%) and much better if compared to Mallampati score (64%). Conclusion: NC/TMD ratio had better accuracy in predicting difficult laryngoscopy than Mallampati score and TMD.
Key word: Mallampati score, Thyromental distance, neck circumference to thyromental (NC/TMD) ratio and difficult visualiation of the larynx