title: Incidence and predictors of difficult laryngoscopy in 11,219 pediatric anesthesia procedures.
abstract: OBJECTIVE
  Difficult laryngoscopy in pediatric patients undergoing anesthesia.
  
  
  OBJECTIVE
  This retrospective analysis was conducted to investigate incidence and predictors of difficult laryngoscopy in a large cohort of pediatric patients receiving general anesthesia with endotracheal intubation.
  
  
  BACKGROUND
  Young age and craniofacial dysmorphy are predictors for the difficult pediatric airway and difficult laryngoscopy. For difficult laryngoscopy, other general predictors are not yet described.
  
  
  METHODS
  Retrospectively, from a 5-year period, data from 11.219 general anesthesia procedures in pediatric patients with endotracheal intubation using age-adapted Macintosh blades in a single center (university hospital) were analyzed statistically.
  
  
  RESULTS
  The overall incidence of difficult laryngoscopy [Cormack and Lehane (CML) grade III and IV] was 1.35%. In patients younger than 1 year, the incidence of CML III or IV was significantly higher than in the older patients (4.7% vs 0.7%). ASA Physical Status III and IV, a higher Mallampati Score (III and IV) and a low BMI were all associated (P < 0.05) with difficult laryngoscopy. Patients undergoing oromaxillofacial surgery and cardiac surgery showed a significantly higher rate of CML III/IV findings.
  
  
  CONCLUSIONS
  The general incidence of difficult laryngoscopy in pediatric anesthesia is lower than in adults. Our results show that the risk of difficult laryngoscopy is much higher in patients below 1 year of age, in underweight patients and in ASA III and IV patients. The underlying disease might also contribute to the risk. If the Mallampati score could be obtained, prediction of difficult laryngoscopy seems to be reliable. Our data support the existing recommendations for a specialized anesthesiological team to provide safe anesthesia for infants and neonates.
authors.affiliation: Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany. sebastian.heinrich@kfa.imed.uni-erlangen.de
authors.forename: Sebastian
authors.initials: S
authors.lastname: Heinrich
authors.forename: Torsten
authors.initials: T
authors.lastname: Birkholz
authors.forename: Harald
authors.initials: H
authors.lastname: Ihmsen
authors.forename: Andrea
authors.initials: A
authors.lastname: Irouschek
authors.forename: Andreas
authors.initials: A
authors.lastname: Ackermann
authors.forename: Joachim
authors.initials: J
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000758:Anesthesia; D015992:Body Mass Index; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D057286:Electronic Health Records; D005260:Female; D005544:Forecasting; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors