Predictors of paediatric difficult intubation according to the experience of a university hospital in a low- and middle-income country: A prospective observational study

Abstract

Background: Difficult airway management is one of the main challenges in paediatric anaesthesia, particularly in low- and middle-income countries.

Aims: The aim of this study was to investigate the main predictors of difficult paediatric intubation.

Methods: In this observational study, we included all children aged less than five years undergoing intra-abdominal surgery with endotracheal intubation. Patients were divided into two groups according to the incidence of difficult intubation. Then, we investigated predictors for difficult paediatric intubation.

Results: We included 217 children, and difficult intubation was observed in 10% of them. Predictors were as follows: Mallampati III-IV class (adjusted odds ratio = 2.21; 95% confidence interval = 1.1-6.4), limited mouth opening (adjusted odds ratio = 2.4; 95% confidence interval = 1.8-3.5), facial dysmorphia (adjusted odds ratio = 2.6; 95% confidence interval = 1.32-7.4) and anaesthesia without muscle relaxant (adjusted odds ratio = 1.8; 95% confidence interval = 1.0-5.1) or without opioids during crash inductions (adjusted odds ratio = 1.7; 95% confidence interval = 1.01-4.8).

Conclusion: Facial dysmorphia and limited mouth opening were predictors of difficult intubation in children. Furthermore, it seems that Mallampati class and anaesthesia technique may also predict challenging intubation, which may guide us to change our perioperative practice.

Keywords: Anaesthetics; Clinical audit; Clinical skills and competence; Difficult airway management; Management and care; Paediatric surgery; Preassessment.