Maddali Madan Mohan, Ali Al-Zaabi Haifa Mohammed, Salim Al-Aamri Is'haq Said, Arora Nishant Ram, Panchatcharam Sathiya Murthi
Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
Anesthesia Residency Program, Oman Medical Specialty Board, Muscat, Oman.
Ann Card Anaesth. 2018 Oct-Dec;21(4):376-381. doi: 10.4103/aca.ACA_47_18.
The primary objective of this study was to identify pre-anesthetic airway assessment parameters that would predict Cormack and Lehane grade III and IV laryngoscopy views in pediatric patients undergoing cardiac catheterization procedures. The secondary end points were to identify factors that would contribute to difficult laryngoscope views in this subset of patients.
Prospective observational study performed at a single tertiary cardiac care center.
199 children below 5 years of age undergoing elective cardiac catheterization were included. Pre-anesthetic airway assessment was done by modified Mallampati grading, lower lip to chin distance [LCD], tragus to mouth angle [TMA], thyromental distance [TMD], neck circumference [NC], and the ratio of height to thyromental distance [RHTMD]. Demographic data including American Society of Anesthesiologists physical status [ASA PS] were recorded for each child. Receiver Operating Characteristic curves were plotted and Areas Under the Curve were measured to identify the best cut off values for each of the airway evaluation method that would predict poor laryngoscopy views as well as assess their accuracy in doing so.
LCD, TMD and low body mass index were found to have good sensitivity, specificity and accuracy in predicting Grade III and IV laryngoscope views. ASA PS grade III and above patients had a significantly higher incidence of poor laryngoscope visualization.
LCD, TMA, TMD, NC, RHTMD and BMI could all be used combinedly as screening tools during pre-anesthetic airway evaluation for predicting difficult laryngoscope views in children. Among these, LCD, TMD along with low body mass index might have better accuracy.
本研究的主要目的是确定麻醉前气道评估参数，以预测接受心导管检查的儿科患者的Cormack和Lehane III级和IV级喉镜视野。次要终点是确定导致该组患者喉镜视野困难的因素。
在一家三级心脏护理中心进行的前瞻性观察研究。
纳入199名5岁以下接受择期心导管检查的儿童。通过改良Mallampati分级、下唇至下巴距离[LCD]、耳屏至口角角度[TMA]、甲状软骨至颏下距离[TMD]、颈围[NC]以及身高与甲状软骨至颏下距离之比[RHTMD]进行麻醉前气道评估。记录每个儿童的人口统计学数据，包括美国麻醉医师协会身体状况分级[ASA PS]。绘制受试者工作特征曲线并测量曲线下面积，以确定每种气道评估方法预测喉镜视野不佳的最佳临界值，并评估其准确性。
发现LCD、TMD和低体重指数在预测III级和IV级喉镜视野方面具有良好的敏感性、特异性和准确性。ASA PS III级及以上患者喉镜视野不佳的发生率显著更高。
LCD、TMA、TMD、NC、RHTMD和BMI均可在麻醉前气道评估时联合用作筛查工具，以预测儿童喉镜视野困难。其中，LCD、TMD以及低体重指数可能具有更高的准确性。
