title: Bedside tests to predict laryngoscopic difficulty in pediatric patients.
abstract: OBJECTIVE
  Pediatric airway management is a priority during anesthesia, critical care and emergency medicine. The purpose of this study is to validate bedside tests that predict airway management difficulty in anesthetized children.
  
  
  METHODS
  Children under 12 years of age were recruited in a cross-sectional study to assess the value of some anthropometric measures as predictors of laryngoscopic difficulty. The patients were divided into three groups by age. Weight, height, neck circumference, BMI (body mass index), inter incisors distance thyromental distance, sternomental distance, frontal plane to chin distance (FPCD) and the Mallampati index were determined and were correlated with the CML (Cormack & Lehane classification).
  
  
  RESULTS
  The incidence of difficult laryngoscopy (CML 3 or 4) was 3.58%. Factors that were significantly associated with laryngoscopic difficulty included short inter incisors distance, high FPCD, thyromental distance, sternomental distance and the Mallampati index. The FPCD/weight index exhibited a higher area under the ROC curve than any other variable considered.
  
  
  CONCLUSIONS
  This study confirms that the FPCD and the FPCD/weight ratio are the most consistent predictors of laryngoscopic difficulty in pediatric patients. For patients over 6 months of age, the IID also correlated with laryngoscopic difficulty. For children who were capable of obeying simple orders, the Mallampati test correlated better with laryngoscopic difficulty than did the Mallampati test with phonation. Our results strongly suggest that skilled professionals should perform airway management in children, especially in patients with a high FPCD or a high FPCD/weight ratio.
authors.affiliation: Department of Anesthesiology, Botucatu Medical School, UNESP, Sao Paulo, Brazil. Electronic address: andremarquesmansano@gmail.com.
authors.forename: André Marques
authors.initials: AM
authors.lastname: Mansano
authors.affiliation: Department of Anesthesiology, Botucatu Medical School, UNESP, Sao Paulo, Brazil. Electronic address: nmodolo@fmb.unesp.br.
authors.forename: Norma Sueli Pinheiro
authors.initials: NS
authors.lastname: Módolo
authors.affiliation: Botucatu Medical School, São Paulo State University, Brazil. Electronic address: leopoldo_muniz@hotmail.com.
authors.forename: Leopoldo Muniz da
authors.initials: LM
authors.lastname: Silva
authors.affiliation: Department of Anesthesiology, Botucatu Medical School, UNESP, Sao Paulo, Brazil. Electronic address: eganem@fmb.unesp.br.
authors.forename: Eliana Maria
authors.initials: EM
authors.lastname: Ganem
authors.affiliation: Department of Anesthesiology, Botucatu Medical School, UNESP, Sao Paulo, Brazil. Electronic address: lbraz@fmb.unesp.br.
authors.forename: Leandro Gobbo
authors.initials: LG
authors.lastname: Braz
authors.affiliation: Botucatu Medical School, São Paulo State University, Brazil. Electronic address: andreaknabe@gmail.com.
authors.forename: Andrea de Carvalho
authors.initials: Ade C
authors.lastname: Knabe
authors.affiliation: Botucatu Medical School, São Paulo State University, Brazil. Electronic address: fernandamfreitas@yahoo.com.br.
authors.forename: Fernanda Moreira de
authors.initials: FM
authors.lastname: Freitas
mesh_terms: D058109:Airway Management / Q000379:methods*; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D000067716:Point-of-Care Testing; D012372:ROC Curve; D012307:Risk Factors
keywords: Anesthesia; Laryngoscopy; Pediatric; Predictors