Predicting difficult airway in apparently normal adult and pediatric patients.

UNLABELLED: The aim of the study was to determine the predicting tests for difficult airway and difficult intubation in apparently normal patients.

METHODS

We were using the literature about the specific tests for predicting difficult airway and single parameters that could be a significant test for prediction of difficult or impossible intubation. Clinical risk factors for difficult intubation in pediatric patients are related to the anatomic differences between pediatric patients and adults. Quantitative evaluation of difficult intubations could be realized using Cormack-Lehane (CL) scale and Mallampati score (without speaking--Mallampati test--and modified Mallampati test during speech). The Cormack-Lehane (CL) scale is a grading system commonly used to describe the view of the larynx during direct laryngoscopy. Grades 3 and 4, in which the glottis is not visualized, are considered difficult intubations. The Mallampati score, estimates the size of the tongue relative to the oral cavity and the ability to open the mouth. This system graded the patient (grades 1 to 4) based on the structures visible in the oropharynx with maximal mouth opening. Grade 3 or 4 suggests a significant chance that the patient will be difficult to intubate.

RESULTS

Our results showed that 24 patients (20 adult patients and 4 pediatric patients), 3.2% from total of 750 involved in the study had difficult intubation (Mallampati grades 3 and 4). 35% of the patients had impaired glottis exposure (grades 3 and 4 of the Cormack-Lehane scale).

CONCLUSION

We used only two criteria for describing both the visibility of the oropharyngeal structures and the quality of the laryngeal view. The effective and reliable prediction requires a combination of several parameters (BMI, head and neck movement, dentition status, upper lip bite test, interincisor gap and thyromental distance).