Evaluation of difficult laryngoscopy with ultrasonography inpediatric patients

In this study, our aim was to preoperatively assess airway structures in pediatric patients using ultrasound and to identify difficult laryngoscopy in advance. Following the receipt of ethical committee approval, our prospective study included 121 patients aged 2-8 years in the supine and neutral head position, classified as American Society of Anesthesiologists (ASA) I-II. Patients who received premedication were taken to the preoperative preparation room in the operating theatre and monitored. Ultrasonography was then used to record measurements of hyoid bone- skin distance (DSHB), epiglottis-skin distance (DSE), anterior commissure-skin distance (DSAC), and the DSAC/DSE ratio. After being taken to the operating room and standard monitoring, patients underwent anesthesia induction. After the administration of rocuronium, a direct laryngoscopy was performed by an experienced anesthetist unaware of the ultrasonography measurement values. During laryngoscopy, the glottic view was assessed and recorded according to the Modified Cormack-Lehane (CM) scoring. CM scores of 1, 2a, and 2b were categorized as easy laryngoscopy, while CM scores of 3-4 were considered difficult laryngoscopy. The findings showed significant differences in modified Mallampati scores among groups with no demographic differences. However, no significant difference was found between the difficult and easy laryngoscopy groups in terms of ultrasound measurements (DSAC, DSHB, DSE) and the DSAC/DSE ratio. In conclusion, in the pediatric population, difficult intubation may not be predictable in advance using neck anterior tissue ultrasonographic measurements (DSAC, DSHB, DSE) and the DSAC/DSE ratio.