Comparison of different predictive tests for difficult airways in pediatrics

Yıl 2020, Cilt: 10 Sayı: 3, 402 - 408, 30.12.2020

Yeliz Kılıç , Meryem Onay , Dilek Ceyhan Ayten Bilir , Birgül Yelken

https://doi.org/10.32448/entupdates.830458

Öz

Objective: There are few studies regarding the use of predictive tests for difficult airways in pediatrics. The aim of this study was to investigate the effectiveness of the modified Mallampati test (MMT), the upper lip bite test (ULBT) and anthropometric measurements of the head and neck in the prediction of difficult airways in children.
Methods: Forty-eight pediatric patients who underwent elective surgery under general anesthesia with endotracheal intubation were recruited for the study. During the preanesthetic evaluation, airway status was evaluated using three methods: MMT, ULBT and anthropometric measurements of the head and neck. Laryngoscopy was performed with a single blade of a videolaryngoscope and airway status was evaluated using the Cormack-Lehane classification. All patients were then classified into two groups: difficult airway or easy airway.
Results: Ten (20.8%) patients were classified as the difficult airway group. In this group, 80% of the patients had MMT grade 3-4 (p=0.001) while 50% of the patients were classified as ULBT 3 (p=0.000). Interincisor distance (ID), hyomental distance (HMD), distance from ear tragus to the corner of the mouth (DTM) and distance from frontal plane to chin (DFC) were significantly different between the groups (p<0.05). In ROC curve analysis, ULBT had the largest area under the curve (AUC=0.880).
Conclusion: ULBT, MMT, HMD and ID were the most consistent predictors of difficult airway status. ULBT was superior to other tests because of its larger AUC and higher sensitivity and specificity rates. However, difficulty in applicability in young children seemed to be the most important limitation of both ULBT and MMT.

Anahtar Kelimeler

Airway management, laryngoscopy, pediatrics

Destekleyen Kurum

nil

Proje Numarası

nil

Kaynakça

• 1. Tay CL, Tan GM, Ng SB. Critical incidents in paediatric anaesthesia: an audit of 10 000 anaesthetics in Singapore. Paediatr Anaesth 2001;11:711-8.
• 2. Mamie C, Habre W, Delhumeau C, Argiroffo CB, Morabia A. Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. Paediatr Anaesth 2004;14:218-24.
• 3. Weiss M, Engelhardt T. Proposal for the management of the unexpected difficult pediatric airway. Paediatr Anaesth 2010;20:454-64.
• 4. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987;42:487-90.
• 5. Salimi A, Farzanegan B, Rastegarpour A, Kolahi AA. Comparison of the upper lip bite test with measurement of thyromental distance for prediction of difficult intubations. Acta Anaesthesiol Taiwan 2008;46:61-5.
• 6. Min JJ, Kim G, Kim E, Lee JH. The diagnostic validity of clinical airway assessments for predicting difficult laryngoscopy using a grey zone approach. J Int Med Res 2016;44:893-904.
• 7. Tokmakoğlu M, Çağlar S, Ünlü S. The comparison of Mallampati and Cormack-Lehane test in prediction of difficult intubation in children. [Article in Turkish] T Clin J Med Sci 2002;22:484-6.
• 8. Nikhar SA, Grover VK, Mathew PJ. Predictors of intubation in children. Indian J Pediatr 2010;77:1392-4.
• 9. Santos AP, Mathias LA, Gozzani JL, Watanabe M. Difficult intubation in children: applicability of the Mallampati index. Rev Bras Anestesiol 2011;61:156-8.
• 10. Inal MT, Memiş D, Sahin SH, Gunday I. Comparison of different tests to determine difficult intubation in pediatric patients. [Article in Portuguese] Rev Bras Anestesiol 2014;64:391-4.
• 11. Mansano AM, Módolo NS, Silva LM, et al. Bedside tests to predict laryngoscopic difficulty in pediatric patients. Int J Pediatr Otorhinolaryngol 2016;83:63-8.
• 12. Khan ZH, Kashfi A, Ebrahimkhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg 2003;96:595-9.
• 13. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984;39:1105-11.
• 14. Aktas S, Atalay YO, Tugrul M. Predictive value of bedside tests for difficult intubations. Eur Rev Med Pharmacol Sci 2015;19:1595-9.
• 15. Etezadi F, Ahangari A, Shokri H, et al. Thyromental height: a new clinical test for prediction of difficult laryngoscopy. Anesth Analg 2013;117:1347-51.
• 16. Mirghassemi A, Soltani AE, Abtahi M. Evaluation of laryngoscopic views and related influencing factors in a pediatric population. Paediatr Anaesth 2011;21:663-7.
• 17. Frei FJ, Ummenhofer W. Difficult intubation in paediatrics. Paediatr Anaesth 1996;6:251-63.
• 18. Huh J, Shin HY, Kim SH, Yoon TK, Kim DK. Diagnostic predictor of difficult laryngoscopy: the hyomental distance ratio. Anesth Analg 2009;108:544-8.
• 19. Hester CE, Dietrich SA, White SW, Secrest JA, Lindgren KR, Smith T. A comparison of preoperative airway assessment techniques: the modified Mallampati and the upper lip bite test. AANA J 2007;75:177-82.
• 20. Eberhart LH, Arndt C, Cierpka T, Schwanekamp J, Wulf H, Putzke C. The reliability and validity of the upper lip bite test compared with the Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation. Anesth Analg 2005;101:284-9.
• 21. Kandemir T, Şavlı S, Ünver S, Kandemir E. Sensitivity of the Combination of Mallampati Scores with Anthropometric Measurements and the Presence of Malignancy to Predict Difficult Intubation. Turk J Anaesthesiol Reanim 2015;43:7-12.