Evaluation of Difficult Airway Predictors in Pediatric Population as a Clinical Investigation

Abstract

Background: Preoperative evaluation of anatomical landmarks and clinical factors help identify potentially difficult airway. Till date there are no criteria or absolute guidelines that can be helpful in detecting difficult airway in pediatric population. Aim: To find the predictors of difficult mask ventilation, difficult laryngoscopy and difficult intubation in pediatric population age 1-5 years. Setting and design a prospective study was conducted in 100 ASA grade I/II pediatric patients between 1-5 years, scheduled for surgery under general anesthesia. Patients with congenital upper airway malformations and those with neck or face swelling or scars were excluded from the study. Material and methods: We assessed the usefulness of interincisor gap (IIG), oropharyngeal view with mouth wide open (without tongue protrusion), modified mallampati Class (MMP) , relationship of maxillary and mandibular incisor during normal jaw closure, neck circumference(NC) , thyromental distance (TMD), sternomental distance (SMD), ratio of height to thyromental distance as preoperative predictors of difficult mask ventilation , laryngoscopy and intubation. Result: Mask ventilation was graded using difficult mask ventilation (DMV) grading, with DMV grade of 3 & 4 occurring in 3 patients (3%). Laryngoscopy was assessed using Cormack and Lehane (C&L) grading system which revealed 3 cases of CL grade III with no case falling under CL grade IV. Ease or difficulty in tracheal intubation was assessed using Intubation difficulty score (IDS) 40% cases showed mild difficulty (0<IDS >5) and 2% showed major difficulty (IDS>5). Conclusion: Interincisor gap, neck cicumferance, sternomental distance was found to be predictors of difficult mask ventilation. Statistically significant correlation was found between difficult laryngoscopy and intubation. Age, best oropharangeal view and thyromental distance were found to be predictors of difficult larngoscopy and intubation. Analysis proved that mask ventilation became easier after administration of muscle relaxant and difficulty decreased after 3 years age. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h

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

“…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.…”

“…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. 31,33 Adults receiving general anesthesia…”

Comparación de diferentes test para determinar la intubación difícil en pacientes pediátricos

“…Descubrimos que el punto de corte ideal de la DTM para prever laringoscopia difícil es de 5,5 cm. Aggarwal et al 18 llevaron a cabo un estudio para descubrir los predictivos de intubación difícil en pacientes pediátricos con edades entre 1 y 5 años. Los autores calcularon la utilidad de la distancia interincisivos, TMM, DTM, distancia mentoesternal, circunferencia del cuello y RADTM.…”

Study of Various Measurements of Intubation in Infants and Their Correlation With Prediction of Difficult Intubation

“…2% cases were observed difficult at laryngoscopy because of large head (hydrocephalus and huge occipital meningo-myelocele) and in one case it was laryngeal oedema which made intubation difficult. Aggarwal A et al 19 in 2012 concluded in their study that as age increases laryngoscopy and intubation becomes easier because after 2years of age airway is more or less similar to adults apart from small in size. This inference was further strengthened by study performed by Junko A et al in 2015 where he concluded that infants who received general anaesthesia repeatedly at different age, CL grade was decreased from 4 to 3 in one and from 3 to 2 in two infants during anaesthesia performed later.…”

“…Gonzalez H found increasing neck circumference associated with problematic intubation in adults. 19 No absolute values are given in literature either for adults or paediatric age group. In our study mean neck circumference was 19.9cm+1.28 in normal laryngoscopy and 21.61cm+0.28 in difficult and was found to be statistically significant (p<.001).…”