Is Airway-Related Pathology the Main Risk Factor for Difficult Intubation in Children Under 6 Years Old?

INTRODUCTION

Evaluating pediatric airways is challenging, particularly in identifying those at risk for difficult intubation, which is often linked to craniofacial malformations. Limited cooperation from preschoolers further complicates this evaluation.

OBJECTIVE

To evaluate the predictive accuracy of the Arné Score in identifying risk factors for difficult intubation in preschool-aged children (under 6 y) and develop a model to prevent difficult laryngoscopy and intubation. Secondary objectives include determining the incidence of difficult intubation and the appropriate age for preanesthetic airway assessments.

METHODS

This retrospective observational study analyzed 1385 patients aged 0 to 16 years, all undergoing general anesthesia and tracheal intubation in 2018 at a tertiary hospital in Barcelona. Among them, 708 were under 6 years. Predictive tests included the Arné Score, with difficult intubation defined by Cormack-Lehane scores, intubation attempts, and alternative device use. Logistic regression analyzed predictors with significant odds ratios.

RESULTS

Unrecorded Mallampati test values were common in children under 6 years (99.04%). Of those without a history, 8.07% faced intubation difficulties, compared with 50% with a history. Relative risk was 6.23, and the odds ratio was 11.46. Among 202 classified with airway difficulties, 82.67% had no intubation issues. Statistically significant associations highlighted greater risks for those with a difficult intubation history.

CONCLUSIONS

Arné Score tests are impractical for children under 6. If no history or airway pathology exists, there's a 95.14% chance of successful intubation. The history of difficult intubation increases risks more than airway pathology alone.