Çocuklarda Zor Entübasyon ile İlişkili Olabilecek Antropometrik Ölçümlerin Belirlenmesi

Öz

Amaç: Zor trakeal entübasyon, perioperatif morbidite ve mortalitenin önemli bir nedenidir. Pediatrik yaş grubunda anatomik ve fizyolojik yapıların farklı olması nedeniyle zor entübasyon sıklığının daha fazla olduğu düşünülmekte olup, bunu önceden saptamak kolay olmayabilir. Elektif operasyon öncesinde değerlendirilen antropometrik ölçümler ve bazı parametrelerin zor entübasyanla ilişkisi değerlendirilmiştir. Materyal ve Metot: Bu kesitsel prospektif çalışma, genel anestezi altında elektif cerrahi uygulanan, 2-14 yaş arasındaki 90 çocuk hastada yapılmıştır. Operasyon öncesinde tüm hastaların yaş, cinsiyet, boy, kilo, vücut yüzey alanı (VYA) ve vücut kitle indeksi (VKI) kayıtları yapıldı. Mallampati skorlaması, baş ve boyun çevresi, tiromental mesafe ölçümleri, baş çevresi/boyun çevresi oranlaması yapıldı. Operasyona alınan hastaların, direk laringoskopi işlemi sırasında Cormack-Lehane (CL) skorlaması ve endotrakeal entübasyon uygulandı. Kolay entübasyon uygulanan çocuklar (CL grade 1 ve 2) Grup 1; zor entübasyon uygulanan çocuklar (CL grade 3 ve 4) Grup 2 olarak tanımlandı. Bulgular: Grup I ve II arasında yaş, boy ve kilo değerleri açısından anlamlı ilişkisi saptanmadı. İki grup arasında, vücut yüzey alanı ve tiromental mesafe ölçümleriyle de anlamlı ilişki saptanmamıştır. 90 hastanın 3 tanesinde Mallampati skoru grade 3 ve 4 (%3.3), 4 tanesinde CL skoru 3 ve 4 (%4.4) saptandı. Mallampati skorlaması ile Cormack-Lehane skorlaması arasında anlamlı bir ilişki saptandı. İki grup arasında, baş/boyun oranları ve VKI açısından anlamlı fark saptanmıştır. Sonuç: Çalışmamızda, elektif ameliyat edilen, normal fiziksel özellikteki, 2-14 yaş çocuk hastalarda, baş çevresi/boyun çevresi oranı ve VKI zor entübasyonu öngörmede prediktif olabileceği bulunmuştur. Bulgularımız, yeni planlanacak ve daha çok sayıda hastayı içeren farklı çalışmalarla desteklenebilir.

Anahtar Kelimeler

• Zor entübasyon
• baş/boyun oranı
• vücut kitle indeksi
• Cormack-Lehane skoru
• Mallampati skoru

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

Öz

Aim: Difficult tracheal intubation is a fundamental cause of perioperative morbidity and mortality. The frequency of difficult intubation is thought to be higher in the pediatric age group due to the different anatomical and physiological structures, and it may not be easy to detect this beforehand. Anthropometric measurements were evaluated before the elective operation and the relationship of some parameters with difficult intubation. Material and Method: This prospective cross-sectional study was conducted on 90 pediatric patients aged 2-14 who underwent elective surgery under general anesthesia. All patients’ age, gender, height, weight, body surface area (BSA), and body mass index (BMI) records were recorded before the operation. Mallampati scoring, head and neck circumference, thyromental distance measurements, and head circumference/neck circumference ratio were performed. Cormack-Lehane (CL) scoring and endotracheal intubation were applied during direct laryngoscopy of the operated patients. Children with easy intubation (CL grade 1 and 2) group 1; children who underwent difficult intubation (CL grade 3 and 4) were defined as group 2. Results: There was no significant relationship between Groups I and II in terms of age, height and weight values. There was no significant relationship between the two groups with BSA and thyromental distance measurements. Mallampati scores were found to be grades 3 and 4 (3.3%) in three of the 90 patients, and CL scores of 3 and 4 (4.4%) in four patients. A significant correlation was found between Mallampati scoring and CL scoring. A statistically significant difference was found between the two groups regarding head/neck ratios and BMI. Conclusion: In our study, head circumference/neck circumference ratio and BMI were found to be helpful while predicting difficult intubation in children with normal physical characteristics, 2-14 years of age, who underwent elective surgery. Our findings can be supported by further studies that will be planned and include more patients.

Anahtar Kelimeler

• Difficult intubation
• head/neck ratio
• body mass index
• Cormack-Lehane score
• Mallampati score

Kaynakça

1. Utting JE. Pitfalls in anesthetic practice. Br J Anaesth 1987;59:877-90.
2. Valois-Gómez T, Oofuvong M, Auer G, et al. Incidence of difficult bag-mask ventilation in children: a prospective observational study. Paediatr Anaesth. 2013;23:920-6.
3. Gupta S, Sharma R, Jain D. Airway assessment: predictors of a difficult airway. Indian J Anaesth. 2005;49:257-62.
4. Gregory GA, Riazi J. Classification and assessment of the difficult pediatric airway. Anesthesiol Clin North America. 1998;16:729-41.
5. Shahhosseini S, Montasery M, Saadati M, et al. Comparative Evaluation of Difficult Intubation Predictors in Children Under Two Years of Ages. Anesth Pain Med. 2021;11: e118931.
6. Mallampati SR. Clinical sign to predict difficult tracheal intubation (hypothesis). Can Anaesth Soc J. 1983;30:316-7.
7. Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32:429-34.
8. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anesthesia. 1987;42:487-90.

9. Lee A, Fan LTY, Gin T et al. A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg. 2006;102:1867-78.
10. Huh J, Shin HY, Kim SH, et al. Diagnostic predictor of difficult laryngoscopy: the hyomental distance ratio. Anesth Analg. 2009;108: 544-8.
11. Khan ZH, Mohammadi M, Rasouli MR, et al. The diagnostic value of the upper lip bite test combined with sternomental distance, thyro-mental distance, and inter incisor distance for prediction of easy laryngoscopy and intubation: a prospective study. Anesth Analg. 2009;109:822–4.
12. Merah NA, Wong DT, Ffoulkes-Crabbe DJ, et al. Modified Mallampati test, thyromental distance, and inter-incisor gap are the best predictors of difficult laryngoscopy in West Africans. Can J Anaesth. 2005;52:291-6.
13. Shirgoska B, Netkovski J. Predicting difficult airway in apparently normal adult and pediatric patients. Prilozi. 2013;34:155-9.
14. Mansano AM, Módolo NSP, Silva LM, et al. Bedside tests to predict laryngoscopic difficulty in pediatric patients. Int J Pediatr Otorhinolaryngol. 2016;83:63-8.
15. Eberhart LHJ, Arndt C, Cierpka T, et al. The reliability and validity of the upper lip bite test compared with the Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation. Anest Analg. 2005;101:284-9.
16. Santos AP, Mathias LA, Gozzani JL, et al. Difficult intubation in children: applicability of the Mallampati index. Revista Brasileira de Anestesiologia, 2011;61:159-62.
17. Kim WH, Ahn HJ, Lee CJ, et al. Neck circumference to thyromental distance ratio: a new predictor of difficult intubation in obese patients. Br J Anaesth 2011;106:743-8.
18. Liu Y, Wang J, Zhong S. Correlation between clinical risk factors and tracheal intubation difficulty in infants with Pierre-Robin syndrome: a retrospective study. BMC Anesthesiol. 2020;20:1-6.