Evaluation of the Acromio-Axillo-Suprasternal Notch Index as a Predictor of Difficult Laryngoscopy in Pediatric Patients: An Observational Study.

BACKGROUND AND

OBJECTIVE

Predicting difficult endotracheal intubation in the pediatric population remains a challenge for anesthesiologists as limited cooperation, unique anatomical conditions, congenital abnormalities, and lack of appropriately sized airway equipment pose additional challenges. Acromioaxillo suprasternal notch index (AASI) has emerged as a promising tool requiring minimal patient cooperation, making it suitable for pediatric use. The objective of the study is to evaluate the effectiveness of AASI in predicting difficult laryngoscopy in children aged 2-10 years undergoing general anesthesia with endotracheal intubation.

MATERIALS AND

METHODS

The cross-sectional observational study was conducted in children (N = 55) aged 2-10 years scheduled for surgery requiring general anesthesia. Preoperative measurements including age, weight, height, Cormack-Lehane grade, application of laryngeal pressure, the number of intubation attempts, and AASI scores, were recorded. The sensitivity, specificity, and overall accuracy of AASI in predicting difficult tracheal intubation were assessed.

RESULTS

The mean age of the children was 5.92 ± 2.88 years, with the majority being girls (70.91%). Increased AASI score, number of intubation attempts, and increased laryngeal pressure were significantly associated with difficult laryngoscopy. A moderate positive correlation was found between AASI and the Cormack-Lehane score (r = 0.5313; P < 0.001). We observed that sensitivity, specificity, and area under curve the ROC curve for AASI (cutoff of >0.51) were 66.67%, 85.29%, and 0.7787 respectively. Logistic regression analysis revealed AASI as a significant predictor of difficult laryngoscopy (P = 0.0026).

CONCLUSION

AASI is a good predictor of difficult laryngoscopy in children aged 2-10 years. It can serve as a valuable preoperative screening tool for identifying high-risk patients.