Mallampati Score and Pediatric Sedation Risk

Written by Clay Smith

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Children needing deep sedation in the ED were not at greater risk for adverse events if they had Mallampati III/IV scores.  But they did need to be repositioned more often than children with Mallampati I/II scores.

Why does this matter?
Prior to performing deep sedation, it is important to do a pre-sedation history and exam.  The Mallampati score is often part of this exam and is a predictor of a difficult airway.  One would expect that a higher score would mean a more dangerous sedation.  Maybe not...

"Smith Score" would be easier to spell but less interesting
This was a prospective study of 575 pediatric patients needing deep sedation, mostly with ketamine, in the ED.  The Mallampati was only obtained on 458 children, which is understandable since younger children often don't want to open their mouths.  Children with Mallampati III/IV scores were compared to I/II scores.  Overall, they did not find an increased risk of adverse events, defined as, "oxygen desaturation < 90%, apnea, laryngospasm, bag-valve-mask ventilation performed, repositioning of patient, emesis, and 'other.'"  Of the variables on this list, Mallampati III/IV children did need repositioning more often than those with a I/II score.

Source
Higher Mallampati Scores Are Not Associated with More Adverse Events During Pediatric Procedural Sedation and Analgesia.  West J Emerg Med. 2018 Mar;19(2):430-436. doi: 10.5811/westjem.2017.11.35913. Epub 2018 Feb 26.

Peer reviewed by Thomas Davis

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