THE PREVALENCE OF DIFFICULT AIRWAY AND ITS ASSOCIATED FACTORS IN PEDIATRIC PATIENTS WHO UNDERWENT SURGERY UNDER GENERAL ANESTHESIA: AN OBSERVATIONAL STUDY.
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Keywords
Pediatrics, difficult airway, pediatric intubation, airway management
Abstract
Background: There are numerous anatomical, physiological, and clinical differences between pediatric and adult airway management. Airway obstruction in children is unquestionably a stressful situation for the medical staff and the patient’s family.
Aim: The prevalence of difficult airway and its associated factors in pediatric patients who underwent surgery under general anesthesia.
Methods: This prospective observational study was performed on 62 children under two years of age that were presenting to pediatric emergency for elective surgery under general anesthesia with endotracheal intubation in SMGS Hospital Jammu. The parameters measured, including age, weight, height, stern omental distance (SMD), mouth opening (MO), neck circumference (NC), acromio-axillo-suprasternal notch index (AASI), and intubation difficulty scale score (IDS). The bivariate and multivariate logistic regression was used to measure the association between the dependent variable (pediatrics difficult airway) and independent variables. p-value <0.05 was used to declare statistical significance.
Results: In this prospective observational study, prevalence of difficult intubation with IDS > 4 was 14% and with IDS > 5 was 2%. The variables, including age, weight, height, and SMD, significantly predicted difficult intubation and cut-off points for these variables were age < 5 months, weight < 5.8 kg, height < 59 cm, and SMD < 5.3 cm respectively. Other variables, such as MO, AASI, NC, and gender, were unreliable predictors for difficult intubation.
Conclusion: Being pediatric patients less than 2 years of age, underweight pediatrics patients, having anticipated difficult airway, were identified as the main factors associated with the greater occurrence of difficult airway in pediatric patients. We found that IDS > 4, age< 5-month, weight < 5.8 kg, and SMD < 5.3 cm are predictors for difficult intubation. It is helpful for the anesthesiologist to measure these predictors before anesthesia is administrated to predict difficult intubation.
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Dr Aprajita
Senior Resident, Department of Anaesthesia, Government Medical College, Jammu, India.
Dr Kartik Samyal
Assistant Professor, Department of Pediatrics, Government Medical College, Kathua, India.
Dr Surjeet Kumar
Assistant Professor, Department of Pediatrics, SMGS, Hospital, Government Medical College, Jammu, India