Comparative Evaluation of Difficult Intubation Predictors in Children Under Two Years of Ages

Abstract

Background: Tracheal intubation is the most reliable way of securing an airway. Pediatric airway management is one of the significant challenges, especially for non-pediatric anesthesiologists. Early airway evaluation for detecting difficult intubation and preventing catastrophic events is necessary before anesthesia, especially in children. Objectives: Therefore, this study was done to compare some valuable adult predictors in children under two years of age. Methods: This prospective descriptive-analytical study was performed on 405 children under two years of age that were referred for elective surgery under general anesthesia with endotracheal intubation in Imam Hossein Hospital, Isfahan. Under sedation in a supine position, we measured items, including age, weight, height, stern omental distance (SMD), mouth opening (MO), neck circumference (NC), acromio-axillo-suprasternal notch index (AASI), and intubation difficulty scale score (IDS). An expert anesthesiologist did laryngoscopy and intubation, and difficult cases were recorded. Results: Our study showed that the frequency of difficult intubation with IDS > 4 was %16, and with IDS > 5 was %3. The variables, including age, weight, height, and SMD, significantly predicted difficult intubation. The cut-off points for age < 6 months, weight < 5/9 kg, height < 61 cm, and SMD < 5/3 cm were obtained, respectively. Other variables, such as MO, AASI, NC, and sex, were unreliable predictors for difficult intubation. Conclusions: We found that IDS > 4, age< 6-month, weight < 5/9 kg, and SMD < 5/3 cm are predictors for difficult intubation. It is helpful for the anesthesiologist to measure these predictions before anesthesia is started to find who has difficult intubation.

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

“…Neither study found a relationship between the thyromental distance and difficult intubation. (5). We think that the head/neck circumference ratio and BMI parameters, which were not evaluated in this study, may be important indicators for our study.…”

“…Studies report that the difficult intubation frequency is higher in children (3,4). When difficult intubation is encountered in the pediatric age group, arterial oxygen saturation decrease rapidly, leading to a decrease in the opportunity for intubation and a life-threatening situation such as brain damage and cardiac arrest (5). Therefore, anesthesiologists need to detect difficult airways in advance, prepare special equipment, and have good experience in airway management in the pediatric age group.…”

“…There is insufficient data for predictive factors for difficult intubation in pediatric patients, and there is no complete consensus on parameters that may be associated with difficult intubation (5,13,14). This study evaluated the relationship between anthropometric measurements, thyromental distance, head circumference/neck circumference ratio, and difficult intubation in children aged 2-14.…”

Airway management in neonates and infants

“…While several adult based studies have suggested simple summations or weighted risk scores for predicting ‘unanticipated’ difficult tracheal intubation based on physical measures (e.g. symptoms of a pathological airway; inter-incisor gap; mandible luxation; thyromental distance; head and neck movement; and Mallampati score), none of these have been validated in children nor is it always possible to assess these parameters 14–16 . The Mallampati score is not feasible in neo-nates and infants as it requires a cooperative patient who can follow verbal commands.…”

“…symptoms of a pathological airway; interincisor gap; mandible luxation; thyromental distance; head and neck movement; and Mallampati score), none of these have been validated in children nor is it always possible to assess these parameters. [14][15][16] The Mallampati score is not feasible in neo-nates and infants as it requires a cooperative patient who can follow verbal commands. Other measures (e.g.…”