• Paediatric anaesthesia · Aug 2012

    Incidence and predictors of difficult laryngoscopy in 11,219 pediatric anesthesia procedures.

    • Sebastian Heinrich, Torsten Birkholz, Harald Ihmsen, Andrea Irouschek, Andreas Ackermann, and Joachim Schmidt.
    • Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany. sebastian.heinrich@kfa.imed.uni-erlangen.de
    • Paediatr Anaesth. 2012 Aug 1;22(8):729-36.

    ObjectiveDifficult laryngoscopy in pediatric patients undergoing anesthesia.AimThis retrospective analysis was conducted to investigate incidence and predictors of difficult laryngoscopy in a large cohort of pediatric patients receiving general anesthesia with endotracheal intubation.BackgroundYoung age and craniofacial dysmorphy are predictors for the difficult pediatric airway and difficult laryngoscopy. For difficult laryngoscopy, other general predictors are not yet described.MethodsRetrospectively, from a 5-year period, data from 11.219 general anesthesia procedures in pediatric patients with endotracheal intubation using age-adapted Macintosh blades in a single center (university hospital) were analyzed statistically.ResultsThe overall incidence of difficult laryngoscopy [Cormack and Lehane (CML) grade III and IV] was 1.35%. In patients younger than 1 year, the incidence of CML III or IV was significantly higher than in the older patients (4.7% vs 0.7%). ASA Physical Status III and IV, a higher Mallampati Score (III and IV) and a low BMI were all associated (P < 0.05) with difficult laryngoscopy. Patients undergoing oromaxillofacial surgery and cardiac surgery showed a significantly higher rate of CML III/IV findings.ConclusionThe general incidence of difficult laryngoscopy in pediatric anesthesia is lower than in adults. Our results show that the risk of difficult laryngoscopy is much higher in patients below 1 year of age, in underweight patients and in ASA III and IV patients. The underlying disease might also contribute to the risk. If the Mallampati score could be obtained, prediction of difficult laryngoscopy seems to be reliable. Our data support the existing recommendations for a specialized anesthesiological team to provide safe anesthesia for infants and neonates.© 2012 Blackwell Publishing Ltd.

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