Evaluation of thyromental height test in prediction of difficult airway in obese surgical patients: An observational study

Background and Aims: Thyromental height test (TMHT) has revealed good potentials for predicting difficult laryngoscopy view (DLV) in non-obese patients, but its accuracy in obese patients is not evident. This study aimed to assess the validity of TMHT as a predictor of DLV in obese surgical patients. Methods: 105 patients, aged 18-60 years, with body mass index (BMI) >30 kg/m2, scheduled for elective surgeries under general anaesthesia with an endotracheal tube inserted using conventional laryngoscope were included. Airway was assessed with TMHT, modified Mallampati test (MMT), neck circumference (NC) and NC/TMHT ratio. The DLV was defined as Cormack-Lehane grade ≥3. The primary endpoint was the validity of TMHT as a predictor of DLV. The secondary endpoints were to compare the accuracy of TMHT with that of the NC, MMT and NC/TMHT ratio as predictors of the difficult airway. Results: The BMI was 43.7 ± 6.6 kg/m2. The DLV cases were 23/105 (21.9%). The MMT, TMHT and NC/TMHT ratio had the best predictive ability of DLV with areas under receiver operating characteristic curve of 0.91, 0.92 and 0.80; at cut-off values >2, 7.9, respectively. MMT and TMHT were the only predictors of DLV by multivariate analysis. Conclusion: In obese surgical patients, TMHT is an excellent predictor of DLV when the cut-off value is