Evaluation of Mallampati and Cormeck-Lehane, tooth morphology and anthropometric measurements, to determine ventilation-entubation difficulty in children

Preoperative airway management is one of the basic rules of anesthesia, on the patients will have surgery under general anesthesia. Difficult airway may expose severe problems for anesthesiologist and also for patient such as hypoxia and death. Especially on pediatrik patients, weak tolerans to hypoxia and fast clinical degradation, an affective preoperative airway assessment become more important. After obtaining the written consents from the Ethics Committe and acceptance of parents, our stody was completed in 7 -15 age, patients in Gaziantep Univercity Medical Faculty, Anesthesiology Department. 200 patients, physical statues of ASA I-II, undergoing general anesthesia were divided in 3 groups; Group 1 (7-9 age n:69), Group 2 (10-12 age n:65), Group 3 (13-15 age n:66). Age, sex, weight, height, body mass index were registered. In our study, the preoperative evaluation of airway in children and adolescents we performed, Modifiye Mallampati clasification (MMC), mandibular protrusion (MP), thyromental distance (TMM), sternomental distance (SMM), atlantooccipital joint mobility (AJM 1-AJM 2) tests, and tooth abnormalities (snag, long upper incisors, number of missing teeth and number of decayed teeth) were observed and recorded. We compared all our findings with Cormeck- Lehane laryngoscopic grading and investigated reliability. After airway assessment, standart monitoring was performed to the patients, fentanyl 0,5-1 mcg/kg iv., propofol 2 mg/kg iv bolus was administered through an appropriate cannula. After the patient can be ventilated with an appropriate face mask, Rocuronium 0,5 mg/kg iv. was administered. 2-3 minutes later, direct laryngoscopy was done with Macintosh, size no: 2, 3 or 4 blades. Cormack-Lehane classification of laryngeal view was compared with predictive difficult airway tests. In our study there was 8 difficult intubation, but no failed intubation.between the groups; TMM, SMM, and number of missing teeth there was statistically significant difference. The other tests have similar findings. After all tests Correlation Analysis with Cormeck-Lehane, we find the highest sensitivity and PPV (%100/%47) as MMC, and the higher spesifity MP test. We presciense that 'TMM ≤6 cm- SMM ≤12cm' used in the prediction of difficult intubation in adults is not available for children and was predicted to vary linearly with height and age. While TMM and SMM adult referance values are suitible for ≥10 years old children, we presciense that ≤5cm TMM and ≤10cm SMM referance values are more useful for 7-9 years old patients.We suggest that, these tests can be more guiding in pediatric patients with appropriate technic and referance values.