Incidence and predictors of poor laryngoscopic view in children undergoing pediatric cardiac surgery.
OBJECTIVE
Previous investigations reported a higher incidence of poor laryngoscopic views in pediatric patients undergoing cardiac surgery. The objective of this study was to analyze why children undergoing cardiac surgery have such an increased incidence of poor laryngoscopic views during anesthesia induction.


METHODS
This study was designed as a retrospective analysis.


METHODS
This analysis was based on a single-center cohort of a university hospital.


METHODS
One thousand one hundred seventy-seven general anesthesia procedures, including a direct laryngoscopic view over a period of 6 consecutive years, in pediatric patients undergoing cardiac surgery.


METHODS
Because of the retrospective character of this study, there were no study-related interventions.


RESULTS
Poor laryngoscopic views were defined as Cormack and Lehane (CML) grade III and IV. The overall incidence of poor laryngoscopic views was 3.5%. In patients younger than 1 year of age, the incidence of CML III or IV was significantly higher than in the older patients (5.6% v 1.7%). None of the patients with CML III/IV findings had Down syndrome; whereas in 9 of 41 patients with CML grade III/IV, a concomitant congenital syndrome like DiGeorge syndrome or CHARGE syndrome was found.


CONCLUSIONS
The general incidence of CML III/IV findings during the induction of anesthesia for pediatric cardiac surgery is more than twice as high as reported in unselected pediatric cohorts. In patients below 1 year of age and in male patients, difficult laryngoscopy is more frequent. Concomitant Down syndrome was not associated with difficult laryngoscopy.
Department of Anesthesia, University Hospital, Erlangen, Germany. sebastian.heinrich@kfa.imed.uni-erlangen.de
Sebastian
S
Heinrich
Torsten
T
Birkholz
Harald
H
Ihmsen
Andrea
A
Irouschek
Andreas
A
Ackermann
Robert
R
Cesnjevar
Joachim
J
Schmidt
D000293:Adolescent; D000367:Age Factors; D015992:Body Mass Index; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D005544:Forecasting; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D009466:Neuromuscular Blocking Agents; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
D009466:Neuromuscular Blocking Agents