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 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. © 2012 Aggarwal A, et al.