Comparison of different predictive tests for difficult airways in pediatrics

Özet

Objective: There are few studies regarding the use ofpredictive tests for difficult airways in pediatrics. The aimof this study was to investigate the effectiveness of themodified Mallampati test (MMT), the upper lip bite test(ULBT) and anthropometric measurements of the headand neck in the prediction of difficult airways in children.Methods: Forty-eight pediatric patients who underwentelective surgery under general anesthesia with endotracheal intubation were recruited for the study. During thepreanesthetic evaluation, airway status was evaluatedusing three methods: MMT, ULBT and anthropometricmeasurements of the head and neck. Laryngoscopy wasperformed with a single blade of a videolaryngoscopeand airway status was evaluated using the Cormack-Lehane classification. All patients were then classified intotwo groups: difficult airway or easy airway.Results: Ten (20.8%) patients were classified as the difficult airway group. In this group, 80% of the patients hadMMT grade 3-4 (p=0.001) while 50% of the patients wereclassified as ULBT 3 (p=0.000). Interincisor distance (ID),hyomental distance (HMD), distance from ear tragus tothe corner of the mouth (DTM) and distance from frontalplane to chin (DFC) were significantly different betweenthe groups (p<0.05). In ROC curve analysis, ULBT had thelargest area under the curve (AUC=0.880).Conclusion: ULBT, MMT, HMD and ID were the most consistent predictors of difficult airway status. ULBT was superior to other tests because of its larger AUC and highersensitivity and specificity rates. However, difficulty in applicability in young children seemed to be the most important limitation of both ULBT and MMT.