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Mallampati classification and laryngeal mask airway insertion

It has been suggested on anatomical grounds that there may be an inverse relationship between difficult tracheal intubation and ease of insertion of the laryngeal mask airway (LMA) [I], but this has not been substantiated. The Mallampati classification system [2], which is modified by Samsoon and Young to include a class 1V [3], is well established as a useful predictor of difficult tracheal intubation. It has been our routine practice to score the ease of insertion of the LMA and to note the modified Mallampati classification. We would like to report a retrospective series of 272 standardised LMA insertions in which the Mallampati score was recorded. The standard technique used was pre-oxygenation followed by induction with either thiopentone or propofol. LMA insertion was attempted 30-60 s later or following loss of lash reflex [4]. Once inserted and the cuff inflated, the position of the LMA was fibreoptically scored from the mask aperture bars [5]. If insertion took more than 20 s or a second attempt was required, this was regarded as a failure. Function was assessed by observation of the rebreathing bag or gentle hand ventilation. The age and weight range was 18-97 years and 36-130 kg respectively. There were 147 men and 125 women, ASA 1-3. The results for fibreoptic scoring are given in Table 1. The overall success rate was 98%. The frequency of Mallampati class in this population is similar to other studies. There was no significant correlation between class 1-111 and fibreoptic scoring. Samsoon and Young class IV was noted on only three occasions and insertion readily achieved. It is difficult to come to any conclusion about the correlation between class IV and ease of insertion with such small numbers. It seems, therefore, that modified Mallampati classification is unhelpful in predicting ease of insertion of the LMA or the fibreoptic positioning of the LMA. This study also fails to support the hypothesis that there is an inverse relationship between ease of insertion and difficult intubation. A large series comparing ease of insertion and direct laryngoscopic scoring would be required to better determine this.