The prevalence of difficult airway and its associated factors in pediatric patients who underwent surgery under general anesthesia: An observational study

Abstract

Background: The airway of an anesthetized patient should be secured with an artificial airway for oxygenation or ventilation. Pediatrics are not small adults which means they are different from adults both anatomically and physiologically. This study aims to determine the prevalence of difficult airway and its associated factors in pediatric patients who underwent surgery under general anesthesia in referral hospitals of Addis Ababa. Methods: A multi-centered cross-sectional study design was employed. The bivariable and multivariable logistic regression was used to measure the association between the dependent variable (pediatrics difficult airway) and independent variables. p-value < 0.05 was used to declare statistical significance. Results: A total of 290 pediatrics patients were included in this study. The prevalence of difficult airway in pediatrics patients who underwent surgery was 19.7%. In multivariate logistic regression, pediatrics patients less than 2 years of age (adjusted odds ratio = 6.768, 95% confidence interval = 2.024, 22.636), underweight pediatrics patients (adjusted odds ratio = 4.661, 95% confidence interval = 1.196, 18.154), pediatrics patients having anticipated difficult airway (adjusted odds ratio = 18.563, 95% confidence interval = 4.837, 71.248), history of the difficult airway (adjusted odds ratio = 8.351, 95% confidence interval = 2.033, 34.302), the experience of anesthetists less than 4 years of age (adjusted odds ratio = 9.652, 95% confidence interval = 2.910, 32.050) had a significant association with pediatrics difficult airway. Conclusion: Being pediatric patients less than 2 years of age, underweight pediatrics patients, having anticipated difficult airway, those anesthetists who do not perform enough pediatric cases were identified as the main factors associated with the greater occurrence of difficult airway in pediatric patients.

Predictive values of the modified Mallampati test, upper lip bite test, thyromental distance and ratio of height to thyromental distance to predict difficult laryngoscopy in pediatric elective surgical patients 5–12 years old at selected Addis Ababa governmental hospitals, Ethiopia: a multicenter cross-sectional study

“…The overall magnitude of difficult laryngoscopy was 15.6% among elective pediatric surgical patients (5-12 years), who were old enough to follow instructions, with no apparent difficult airway indicator in our study. The result of our study was higher than other studies that found 1% [7], 1.35% [8], 3% [9], 3.58% [10], 7.2% [11], and 10.4% [12] incidence of DL. In contrast, our result was lower than that of another study [13], which found a 20.8% prevalence of DL.…”

“…The discrepancies in the magnitude could be due to the use of different types of laryngoscopes which could affect the Cormack and Lehane grading because optimum intubation attempts are associated with alternative laryngoscope blades selection [ 23 ]. Furthermore, it could be due to the level of experience of the practitioner which could have a significant association with a difficult laryngoscopy [ 11 , 23 , 24 ], and it could also be due to differences in the patient's ethnicity, anthropology, sample size and definition of difficult laryngoscopy. In our study, there was no Cormack and Lehane grade IV, and there was also no difficult or failed intubation.…”

“…Among all anesthesia-related deaths in pediatrics, 13% are related to difficulties during laryngoscopy and intubation [6]. The prevalence of DL ranges from 1% to 20.8% in pediatrics [7][8][9][10][11][12][13].…”

Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013–2020)

“…Consistent with previous studies, a relatively high percentage of underweight patients were noted to have a known difficult airway or difficult airway features which in anesthesia practice is associated with difficult direct laryngoscopy (13, 14). Furthermore, in otherwise healthy children, being underweight is associated with decreased predicted forced vital capacity and vital capacity on pulmonary function testing, which could make such individuals prone to hypoxemia and adverse events were they critically ill and in need of TI (26).…”

“…Regarding pediatric patients, anesthesia literature suggests that body mass index (BMI) percentile is not associated with difficult intubation in children between 2 and 18 years old (10). Previous anesthesia literature covers both obesity and underweight pediatric patients, suggesting a range of influences for difficult intubations (11)(12)(13)(14). In the pediatric intensive care literature there is very little information, except for a previous NEAR4KIDS registry dataset (2010)(2011)(2012)(2013)(2014)(2015) that identified an association between increased body weight and greater odds of needing cricoid pressure at the time of TI (15).…”