Comparison of different tests to determine difficult intubation in pediatric patients

İnal, Mehmet Turan; Memiş, Dilek; Şahin, Sevtap Hekimoğlu; Günday, Işıl

doi:10.1016/j.bjane.2014.02.001

Cited by 10 publications

(9 citation statements)

References 16 publications

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“…[1] Contrary to adults, a limited number of studies have attempted to identify the effectiveness and usefulness of different airway assessments or scoring systems for the prediction of difficult airways in the pediatric population. [7][8][9][10][11]16] In routine anesthesia practice, some observational parameters such as head extension width, anatomical shape of the mandible (especially degree of prognation) and tongue thickness are widely used to predict difficult airways. [17] However, there is a lack of data regarding the association between certain anatomical measurements of the head and neck and difficult airway status in anesthetized children.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] However, there are a limited number of studies in the literature regarding the use of such diagnostic tests in the pediatric population. [7][8][9][10][11] In the present study, compared with the Cormack-Lehane classification, the effectiveness of widely used bedside tests including MMT and ULBT and anthropometric measurements of the head and neck was examined to predict difficult airway status in pediatric patients under general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of different predictive tests for difficult airways in pediatrics

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of different predictive tests for difficult airways in pediatrics

et al. 2020

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“…This binary risk assessment is then used to predict a research outcome of either difficult laryngoscopy or of difficult intubation. The commonly used standard for difficult laryngoscopy is a Cormack-Lehane direct laryngeal view classification of grade III or IV, 5,23,[25][26][27][28][29][30][31] although the percentage of glottic opening score has also been used. 32 When the chosen outcome is instead difficult intubation, this has been coded as either a numeric threshold (eg, 3 or more unsuccessful attempts 26 ) or a composite score based on the number of attempts and ultimate intubation failure.…”

Section: How Well Does the Mallampati Score Predict Difficult Laryngomentioning

confidence: 99%

Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation?

Green

Roback

2019

Annals of Emergency Medicine

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We review the literature in regard to the accuracy, reliability, and feasibility of the Mallampati score as might be pertinent and applicable to emergency department (ED) airway management and procedural sedation. This 4-level pictorial tool was devised to predict difficult preoperative laryngoscopy and intubation, but is now also widely recommended as a routine screening element before procedural sedation. The literature evidence demonstrates that the Mallampati score is inadequately sensitive for the identification of difficult laryngoscopy, difficult intubation, and difficult bag-valve-mask ventilation, with likelihood ratios indicating a small and clinically insignificant effect on outcome prediction. Although it is important to anticipate that patients may have a difficult airway, there is no specific evidence that the Mallampati score augments or improves the baseline clinical judgment of a standard airway evaluation. It generates numerous false-positive warnings for each correct prediction of a difficult airway. The Mallampati score is not reliably assessed because independent observers commonly grade it differently. It cannot be evaluated in many young children and in patients who cannot cooperate because of their underlying medical condition. The Mallampati score lacks the accuracy, reliability, and feasibility required to supplement a standard airway evaluation before ED airway management or procedural sedation. [

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“…The Mallampati score is used to predict difficulty with intubation, with those who score III or IV being more difficult to intubate, and has been validated in children. 20 – 23 Given that a higher Mallampati score may indirectly indicate children who have potentially difficult or anatomically different airways, this classification scheme may add important risk information to pediatric pre-PSA assessments. Thus, the objective of this study was to assess whether pre-PSA Mallampati score can predict adverse events during pediatric PSA.…”

Section: Introductionmentioning

confidence: 99%

Higher Mallampati Scores Are Not Associated with More Adverse Events During Pediatric Procedural Sedation and Analgesia

Iyer¹,

Pitetti²,

Vitale³

2018

WestJEM

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IntroductionProcedural sedation and analgesia (PSA) is used by non-anesthesiologists (NAs) outside of the operating room for several types of procedures. Adverse events during pediatric PSA that pose the most risk to patient safety involve airway compromise. Higher Mallampati scores may indirectly indicate children at risk for airway compromise. Medical governing bodies have proposed guidelines for PSA performed by NAs, but these recommendations rarely suggest using Mallampati scores in pre-PSA evaluations. Our objective was to compare rates of adverse events during pediatric PSA in children with Mallampati scores of III/IV vs. scores of Mallampati I/II.MethodsThis was a prospective, observational study. Children 18 years of age and under who presented to the pediatric emergency department (PED) and required PSA were enrolled. We obtained Mallampati scores as part of pre-PSA assessments. We defined adverse events as oxygen desaturation < 90%, apnea, laryngospasm, bag-valve-mask ventilation performed, repositioning of patient, emesis, and “other.” We used chi-square analysis to compare rates of adverse events between groups.ResultsWe enrolled 575 patients. The median age of the patients was 6.0 years (interquartile range = 3.1,9.9). The primary reasons for PSA was fracture reduction (n=265, 46.1%). Most sedations involved the use of ketamine (n= 568, 98.8%). Patients with Mallampati scores of III/IV were more likely to need repositioning compared to those with Mallampati scores of I/II (p=0.049). Overall, patients with Mallampati III/IV scores did not experience a higher proportion of adverse events compared to those with Mallampati scores of I/II. The relative risk of any adverse event in patients with Mallampati scores of III/IV (40 [23.8%]) compared to patients with Mallampati scores of I/II (53 [18.3%]) was 1.3 (95% confidence interval [0.91–1.87]).ConclusionPatients with Mallampati scores of III/IV vs. Mallampati scores of I/II are not at an increased risk of adverse events during pediatric PSA. However, patients with Mallampati III/IV scores showed an increased need for repositioning, suggesting that the sedating physician should be vigilant when performing PSA in children with higher Mallampati scores.

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Comparison of different tests to determine difficult intubation in pediatric patients

Cited by 10 publications

References 16 publications

Comparison of different predictive tests for difficult airways in pediatrics

Comparison of different predictive tests for difficult airways in pediatrics

Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation?

Higher Mallampati Scores Are Not Associated with More Adverse Events During Pediatric Procedural Sedation and Analgesia

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