title: Association of neck circumference with perioperative adverse respiratory events in children.
abstract: OBJECTIVE
  The purpose of this investigation was to examine the association of neck circumference (NC) with perioperative respiratory adverse events in children undergoing elective noncardiac surgery, a relationship that has not been previously characterized.
  
  
  METHODS
  Using a prospective, observational design, we studied children aged 6 to 18 years undergoing elective noncardiac surgeries at our institution. Trained research assistants collected clinical (including perioperative adverse events) and anthropometric data from all subjects. Patients were stratified into 2 classes: high NC versus low NC on the basis of age- and gender-specific receiver operating characteristic curve analysis. Subsequently, univariate factors associated with high NC were explored, and odds ratios for the occurrence of perioperative adverse events were then calculated from logistic regression after controlling for clinically relevant cofactors.
  
  
  RESULTS
  Among the 1102 patients, the prevalence of high NC was 24.3%. NC was positively correlated with age and other anthropometric parameters. Children with high NC were more likely to be loud snorers and have a history of bronchial asthma, hypertension, and type 2 diabetes. Composite adverse airway events were more frequent in children with a large NC. There was no significant association between high NC and difficult laryngoscopy in our study population.
  
  
  CONCLUSIONS
  NC was positively correlated with other indices of obesity in children, and large NC (indicative of central obesity) was associated with some adverse respiratory events in these children undergoing noncardiac surgery. NC could be a useful clinical screening tool for the occurrence of perioperative adverse respiratory events in children.
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor , MI 48109-0048, USA. onafiu@med.umich.edu
authors.forename: Olubukola O
authors.initials: OO
authors.lastname: Nafiu
authors.forename: Constance C
authors.initials: CC
authors.lastname: Burke
authors.forename: Ruchika
authors.initials: R
authors.lastname: Gupta
authors.forename: Robert
authors.initials: R
authors.lastname: Christensen
authors.forename: Paul I
authors.initials: PI
authors.lastname: Reynolds
authors.forename: Shobha
authors.initials: S
authors.lastname: Malviya
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000886:Anthropometry; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009333:Neck / Q000033:anatomy & histology*; D016017:Odds Ratio; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012120:Respiration Disorders / Q000453:epidemiology* / Q000209:etiology; D018570:Risk Assessment; D012737:Sex Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods