Clinical criteria for prediction of difficult airway in adults may not be applicable in children and available literature on the topic is limited. The objective of this prospective observational study was to assess th...Clinical criteria for prediction of difficult airway in adults may not be applicable in children and available literature on the topic is limited. The objective of this prospective observational study was to assess the usefulness of Mallampati classification, thyromental distance (Tm) and distance from tragus to nares (Tn) in two groups of pediatric patients, those who are less than five and above five years of age, and to correlate these assessments with different grades of Cormack and Lehane (C&L) classification. One hundred and ninety six pediatric patients from one month to eight years of age, ASA grade I and II and planned for elective surgery under general anesthesia with tracheal intubation were recruited. Age, gender, weight (kg), BMI, distance between tragus and nares (cm), Mallampati grades and thyromental distance (cm) were noted preoperatively. Relationship of these variables with C&L grading at the time of laryngoscopy was recorded. C&L grades 2 & 3 was observed in 28 patients in younger age group (n = 120) as compared to two children above 5 years (n = 76) (p < 0.001). C&L grade 3 was seen with decreasing tragus to nares distance (p p = 0.025) in younger age group. In conclusion, this study showed that distance between tragus to nares, Mallampati classification (if applicable) and thyromental distance can be useful for assessment of difficult airway in children less than five years of age.展开更多
Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a p...Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a preanesthetic evaluation that may be capable of predicting a difficult intubation with the conditions encountered at laryngoscopy and endotracheal intubation. Eighty-one patients submitted to general anesthesia were evaluated at a preanesthetic consultation according to the modified Mallampati classification, the Wilson score and the American Society of Anesthesiologists (ASA) difficult airway algorithm. Findings were then correlated with the Cormack-Lehane classification and with the number of attempts at endotracheal intubation. No statistically significant correlations were found between the patients’ Mallampati classification and their Cormack-Lehane grade or between the Mallampati classification and the number of attempts required to achieve endotracheal intubation. Laryngoscopy proved difficult in four patients and in all of these cases the Wilson score had been indicative of a possibly difficult airway, highlighting its good predicting sensitivity. However, the specificity of this test was low, since another 24 patients had the same Wilson score but were classified as Cormack-Lehane I/II. Moreover, two patients who had a Wilson score ≥ 4 were also classified as Cormack-Lehane grade I/II. The study concluded that the Wilson score, although seldom used in clinical practice, is a highly sensitive predictor of a difficult airway;its specificity, however, is low.展开更多
文摘Clinical criteria for prediction of difficult airway in adults may not be applicable in children and available literature on the topic is limited. The objective of this prospective observational study was to assess the usefulness of Mallampati classification, thyromental distance (Tm) and distance from tragus to nares (Tn) in two groups of pediatric patients, those who are less than five and above five years of age, and to correlate these assessments with different grades of Cormack and Lehane (C&L) classification. One hundred and ninety six pediatric patients from one month to eight years of age, ASA grade I and II and planned for elective surgery under general anesthesia with tracheal intubation were recruited. Age, gender, weight (kg), BMI, distance between tragus and nares (cm), Mallampati grades and thyromental distance (cm) were noted preoperatively. Relationship of these variables with C&L grading at the time of laryngoscopy was recorded. C&L grades 2 & 3 was observed in 28 patients in younger age group (n = 120) as compared to two children above 5 years (n = 76) (p < 0.001). C&L grade 3 was seen with decreasing tragus to nares distance (p p = 0.025) in younger age group. In conclusion, this study showed that distance between tragus to nares, Mallampati classification (if applicable) and thyromental distance can be useful for assessment of difficult airway in children less than five years of age.
文摘Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a preanesthetic evaluation that may be capable of predicting a difficult intubation with the conditions encountered at laryngoscopy and endotracheal intubation. Eighty-one patients submitted to general anesthesia were evaluated at a preanesthetic consultation according to the modified Mallampati classification, the Wilson score and the American Society of Anesthesiologists (ASA) difficult airway algorithm. Findings were then correlated with the Cormack-Lehane classification and with the number of attempts at endotracheal intubation. No statistically significant correlations were found between the patients’ Mallampati classification and their Cormack-Lehane grade or between the Mallampati classification and the number of attempts required to achieve endotracheal intubation. Laryngoscopy proved difficult in four patients and in all of these cases the Wilson score had been indicative of a possibly difficult airway, highlighting its good predicting sensitivity. However, the specificity of this test was low, since another 24 patients had the same Wilson score but were classified as Cormack-Lehane I/II. Moreover, two patients who had a Wilson score ≥ 4 were also classified as Cormack-Lehane grade I/II. The study concluded that the Wilson score, although seldom used in clinical practice, is a highly sensitive predictor of a difficult airway;its specificity, however, is low.
