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BACKGROUND & AIMSSeveral pre-operative screening tools are used in adult. Wide range of pediatric anatomical & developmental differences (especially with infants) makes uses of adult clinical predictors in challenge. The aim of our study is to assess various measurements of intubation in infants and their correlation with difficult laryngoscopy. MATERIAL AND METHODSThis prospective randomized study conducted in 100 infants. We assessed the usefulness of neck length (NL), neck circumference (NC), Head Circumference, (HC) ratio of NC/NL and introduced length of laryngoscope blade as predictors of difficult laryngoscopy and intubation. RESULTNC, NL, HC and ratio of NC/NL were significantly associated with incidence of difficult laryngoscopy and intubation. As this ratio increases difficulty at laryngoscopy increases (p<.001). Difficult laryngoscopy was assessed using Cormack Lehane grading. We found as age increases laryngoscopy becomes easier. (p<0.05) CONCLUSIONThere is no single anatomical measurement of intubation in infants in our study we measured NC, NL, NC/NL, HC and introduced length of laryngoscope blade which were found to be important predictors of difficult laryngoscopy and intubation. Statistical significant correlation was found between age and Cormack Lehane grades. In infants, various congenital malformations are highly associated with difficult laryngoscopy and intubation.

Guillain-Barré syndrome (GBS) is an autoimmune inflammatory polyneuropathy, which can be challenging to diagnose due to variability in the initial presenting features. Pain, flaccid paresis, motor sensory disturbance, hyporeflexia, and autonomic dysfunction are the typical manifestations, although atypical features, such as ataxia, neck stiffness, dysphagia, ophthalmoplegia, bulbar palsy, and isolated upper limb weakness, may be seen. It may also progress to fatal respiratory depression. As such, timely diagnosis and treatment are essential. We present the case of a 41-year-old man who presented with a four-day history of acute-onset bilateral lower extremity swelling, decreased motor strength, diffuse muscle pain, hyporeflexia, and absent vibratory sensation. After admission, symptoms worsened, and the patient developed new-onset swallowing difficulty and urinary retention. Neurological examination findings of hyporeflexia and flaccid paralysis, along with normal thyroid function, and the absence of cord compression on spinal MRI pointed toward the diagnosis of GBS. Nerve conduction studies (NCS) and concentric electromyography (EMG) confirmed the diagnosis. The patient was treated with intravenous immune globulin (IVIG) and eventually discharged to a rehabilitation facility after a 12-day hospital stay. Later, the patient developed contractures and chronic pain consistent with post-GBS syndrome, for which we referred him for pain management and physical therapy. A rapidly progressive weakness with autonomic dysfunction should prompt suspicion of GBS and should be treated with intravenous immunoglobulins or plasma exchange without further delay.

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