Comparison of endotracheal tube selection using age-based formulas across body-mass index groups in pediatric patients undergoing nasal intubation for dental treatment under general anesthesia

Hande Güngör; Ayşe İnce; Sümeyye Yıldız; Tümay Uludağ Yanaral

doi:10.47582/jompac.1862977

Comparison of endotracheal tube selection using age-based formulas across body-mass index groups in pediatric patients undergoing nasal intubation for dental treatment under general anesthesia

Abstract

Aims: Accurate endotracheal tube (ETT) selection is essential for pediatric nasal intubation, especially when using age-based predictive formulas. The modified Motoyama formula, which adjusts for nasal intubation by selecting a slightly smaller internal diameter and adding length to depth, is commonly used. However, its accuracy across different body-mass index (BMI) groups remains uncertain. Methods: This retrospective study included 677 pediatric patients aged 2–10 years who underwent nasal intubation for dental procedures under general anesthesia. Actual ETT internal diameters and insertion depths were compared with values predicted by the modified Motoyama formula. Patients were stratified by BMI percentile into four groups. Statistical comparisons and Bland–Altman analyses were performed to evaluate prediction accuracy and agreement. Results: The median ETT diameter (4.5 mm) closely matched the modified Motoyama estimate (4.25 mm; p=0.054), while the modified Motoyama formula significantly overestimated ETT insertion depth (actual: 15.5 cm vs. predicted: 16.5 cm), with a median difference of –1.5 cm (IQR: –3.0 to 0.0; p<0.001). BMI showed a weak but significant correlation with prediction errors for both diameter (r=0.165) and depth (r=0.185). No significant variation was found based on chronic disease status. Conclusion: The modified Motoyama formula accurately predicts ETT diameter but tends to overestimate insertion depth in pediatric nasal intubation. Although higher BMI was associated with greater prediction error, this relationship was weak, suggesting that while age-based formulas remain useful, BMI-related variability should be interpreted cautiously when applying these formulas to improve airway safety and accuracy.

Keywords

Supporting Institution

NONE

Ethical Statement

This retrospective study was approved by the Clinical Research Ethics Committee of Istanbul Medipol University on 22/06/2023 (Ethics Committee No: E-10840098-772.02-3949; Decision No: 532). The research was carried out in compliance with institutional ethical standards and with the principles of the 1964 Declaration of Helsinki, including its subsequent amendments and equivalent guidelines.

Thanks

NONE

References

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Details

Primary Language

English

Subjects

Anaesthesiology

Journal Section

Research Article

Authors

Hande Güngör ^*
0000-0002-8920-1516
Türkiye

Ayşe İnce
0000-0003-2082-2602
Türkiye

Sümeyye Yıldız
0000-0002-8155-1618
Türkiye

Tümay Uludağ Yanaral
0000-0003-3917-8183
Türkiye

Publication Date

March 27, 2026

Submission Date

January 13, 2026

Acceptance Date

February 25, 2026

Published in Issue

Year 2026 Volume: 7 Number: 2

DOI

https://doi.org/10.47582/jompac.1862977

IZ

https://izlik.org/JA99HF35WU

Cite

RIS / Bibtex

APA

Güngör, H., İnce, A., Yıldız, S., & Uludağ Yanaral, T. (2026). Comparison of endotracheal tube selection using age-based formulas across body-mass index groups in pediatric patients undergoing nasal intubation for dental treatment under general anesthesia. Journal of Medicine and Palliative Care, 7(2), 249-254. https://doi.org/10.47582/jompac.1862977

AMA

1.Güngör H, İnce A, Yıldız S, Uludağ Yanaral T. Comparison of endotracheal tube selection using age-based formulas across body-mass index groups in pediatric patients undergoing nasal intubation for dental treatment under general anesthesia. J Med Palliat Care / JOMPAC / jompac. 2026;7(2):249-254. doi:10.47582/jompac.1862977

Chicago

Güngör, Hande, Ayşe İnce, Sümeyye Yıldız, and Tümay Uludağ Yanaral. 2026. “Comparison of Endotracheal Tube Selection Using Age-Based Formulas across Body-Mass Index Groups in Pediatric Patients Undergoing Nasal Intubation for Dental Treatment under General Anesthesia”. Journal of Medicine and Palliative Care 7 (2): 249-54. https://doi.org/10.47582/jompac.1862977.

EndNote

Güngör H, İnce A, Yıldız S, Uludağ Yanaral T (March 1, 2026) Comparison of endotracheal tube selection using age-based formulas across body-mass index groups in pediatric patients undergoing nasal intubation for dental treatment under general anesthesia. Journal of Medicine and Palliative Care 7 2 249–254.

IEEE

[1]H. Güngör, A. İnce, S. Yıldız, and T. Uludağ Yanaral, “Comparison of endotracheal tube selection using age-based formulas across body-mass index groups in pediatric patients undergoing nasal intubation for dental treatment under general anesthesia”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 2, pp. 249–254, Mar. 2026, doi: 10.47582/jompac.1862977.

ISNAD

Güngör, Hande - İnce, Ayşe - Yıldız, Sümeyye - Uludağ Yanaral, Tümay. “Comparison of Endotracheal Tube Selection Using Age-Based Formulas across Body-Mass Index Groups in Pediatric Patients Undergoing Nasal Intubation for Dental Treatment under General Anesthesia”. Journal of Medicine and Palliative Care 7/2 (March 1, 2026): 249-254. https://doi.org/10.47582/jompac.1862977.

JAMA

1.Güngör H, İnce A, Yıldız S, Uludağ Yanaral T. Comparison of endotracheal tube selection using age-based formulas across body-mass index groups in pediatric patients undergoing nasal intubation for dental treatment under general anesthesia. J Med Palliat Care / JOMPAC / jompac. 2026;7:249–254.

MLA

Güngör, Hande, et al. “Comparison of Endotracheal Tube Selection Using Age-Based Formulas across Body-Mass Index Groups in Pediatric Patients Undergoing Nasal Intubation for Dental Treatment under General Anesthesia”. Journal of Medicine and Palliative Care, vol. 7, no. 2, Mar. 2026, pp. 249-54, doi:10.47582/jompac.1862977.

Vancouver

1.Hande Güngör, Ayşe İnce, Sümeyye Yıldız, Tümay Uludağ Yanaral. Comparison of endotracheal tube selection using age-based formulas across body-mass index groups in pediatric patients undergoing nasal intubation for dental treatment under general anesthesia. J Med Palliat Care / JOMPAC / jompac. 2026 Mar. 1;7(2):249-54. doi:10.47582/jompac.1862977