Assessment of airway in pediatric patients during pre anesthetic check up and incidence of difficult intubation

Dr Mahmood Mirza; Dr J.V.Subba Rao; Dr  Parveen N

Volume : VI, Issue : IV, April - 2016

Assessment of airway in pediatric patients during pre anesthetic check up and incidence of difficult intubation

Dr Mahmood Mirza, Dr J. V. Subba Rao, Dr Parveen N

Abstract :

Aim: To study the assessment of airway in pediatric patients during pre –anesthetic check up and incidence of difficult intubation. Background Difficult airway is defined as the clinical situation in which a conventionally trained anesthesiologist experiences difficulty either with face mask ventilation of the upper airway or difficulty with tracheal intubation or both. Incidence of difficult intubation occurs in 1.5–8.5% of general anaesthetics. A rational approach to airway assessment, therefore, naturally includes a detailed history, a careful physical examination and inspection of relevant X–rays whenever possible. The inability to intubate a patient is an acknowledged fear among anesthesia professionals. To allay this fear, researchers have developed methods for predicting whether intubation of a particular patient will be easy or difficult. All preoperative airway assessments are evaluated according to their respective sensitivity, specificity, and positive predictive value. Materials and Method 100 pediatric patients aged 1–12 of either sex with ASA grade I & II, scheduled for an elective surgical procedure under general anesthesia were studied. These patients ranged between 1–12 years of age. During pre–anesthetic assessment distance of mentum to thyroid notch when neck is fully extended. It reflects the location of vocal cords, distance of hyoid bone to the mentum, opening of oral cavity and movement of temporomandibular joint on the opening of mouth were studied. An assessment of airways was carried out by Modified Mallampati and modification of modified Mallampati criteria, using tongue depressor over anterior 2/3rd of the tongue. The frequency of abnormal distances like mentum to thyroid notch (TMD), mentum to hyoid notch (HMD), interincisor gap (IIG) and different grades of oropharynx on inspection were studied by modified Mallampati and modification of modified Mallampati criteria. Results The total number of patients with difficult laryngoscopy (grade III and grade IV larynx) was 1 (1%). The total number of patients with difficult pharynx on inspection were 9 (9%) by modified Mallampati criteria and 2 (2%) by modification of modified Mallampati criteria. The incidence of thyromental distance (TMD) < 3 fingers, was found in 3 (3%) patients. HMD <2 fingers was found in 2 patients. Conclusion These simple tests for assessment of pediatric airway may be used for better predictability, save time, and avoid unnecessary use of sophisticated equipments