Determination of Anthropometric Measurements that may be Associated with Difficult Intubation in Children

Abstract

Aim: Difficult tracheal intubation is a fundamental cause of perioperative morbidity and mortality. The frequency of difficult intubation is thought to be higher in the pediatric age group due to the different anatomical and physiological structures, and it may not be easy to detect this beforehand. In this study, we recruited children aged 2-14 years. Anthropometric measurements were evaluated before the elective operation and the relationship of some parameters with difficult intubation.
 Material and Method: This prospective cross-sectional study was conducted on 90 pediatric patients aged 2-14 who underwent elective surgery under general anesthesia. All patients' age, gender, height, weight, body surface area (BSA), and body mass index (BMI) records were recorded before the operation. Mallampati scoring, head and neck circumference, thyromental distance measurements, and head circumference/neck circumference ratio were performed. Cormack-Lehane (CL) scoring and endotracheal intubation were performed during direct laryngoscopy of the operated patients. Group 1 easily intubated children (CL grades 1 and 2); group 2 was defined as children who underwent difficult intubation (CL grades 3 and 4).
 Results: Age, height, and weight had no significant relationship between groups 1 and 2. There was no significant relationship between the two groups with BSA and thyromental distance measurements. Mallampati scores were found to be grades 3 and 4 (3.3%) in three of the 90 patients, and CL scores of 3 and 4 (4.4%) in four patients. A significant correlation (dependence) was found between Mallampati scoring and CL scoring. A statistically significant difference was found between the two groups regarding head/neck ratios and BMI.
 Conclusion: Head circumference/neck circumference ratio and BMI may predict difficult intubation in children aged 2-14 years with normal physical characteristics who underwent elective surgery. It can be used simultaneously to predict difficult preoperative intubation.