Do conventional predictors of “Difficult airway” truly predict difficult airway? Experience with cleft surgeries

S Nanayakkara,S D I Nanayakkara,P Wijekoon,C Sewwandi

doi:10.4038/sljm.v30i1.244

Abstract

Background: We designed this prospective observational study in order to evaluate whether conventional predictors of “Difficult airway” truly predict difficult airway in patients who present for cleft surgeries at Cleft Centre Peradeniya. Methods: One hundred and two babies between the ages of 2 months to 18 months who underwent cleft lip or palate repairs at Cleft centre, Peradeniya August 2015 to April 2016 were included in the study. For each of the patients, we gave a grade for the degree of mouth opening and the laryngoscopic view prior to surgery. Results: Out of the 102 participants, 9.8% of patients had difficult laryngoscopy. At least one out of seventeen studied “predictors of difficult airway,” was found in seven patients out of the 10 in whom laryngoscopy was difficult. There was a significant association of difficult laryngoscopy with reduced mouth opening. Furthermore, factors such as the presence of microstomia, micrognathia, retrognathia, and short neck were significantly associated with difficult laryngoscopy in Cleft Lip and Cleft palate patients who underwent surgical repair.

Highlights

Cleft deformities are considered the most common craniofacial abnormality, [1,2] with the incidence being 1 in 600 to 700 live births in the world [3,4] and cleft palate alone being 1in 2000 live births. [4] In Sri Lanka, cleft abnormalities occur at a rate of0.83 per 1000 live births. [5] Generally, cleft lip repair and cleft palate repair are carried out at 4-5 months and 9-12 months respectively. [6] Establishing airway is always a challenge in paediatric anaesthetic practice
The basic characteristics of the patients who underwent cleft palate and cleft lip repair surgeries are summarized in table 1
The Fishers exact test (p = 0.0048) proved that there was a significant association between the mouth opening class and the laryngoscopic view grade

Summary

Introduction

Cleft deformities are considered the most common craniofacial abnormality, [1,2] with the incidence being 1 in 600 to 700 live births in the world [3,4] and cleft palate alone being 1in 2000 live births. [4] In Sri Lanka, cleft abnormalities occur at a rate of0.83 per 1000 live births. [5] Generally, cleft lip repair and cleft palate repair are carried out at 4-5 months and 9-12 months respectively. [6] Establishing airway is always a challenge in paediatric anaesthetic practice. [7] Difficult airway access leading to delays in establishing the airway together with a higher oxygen consumption rate and limited body oxygen reserves due to a lower functional residual capacity makes a paediatric patient vulnerable for hypoxia during induction of anaesthesia. Previous researchers have revealed factors associated with an increase of airway complications and difficult intubation. These factors are mostly anatomical such as those deformities making it difficult to place the laryngoscope blade [14], the presence of associated facial deformities such as micrognathia [12,15] and retrognathia. We designed this prospective observational study in order to evaluate whether conventional predictors of “Difficult airway” truly predict difficult airway in patients who present for cleft surgeries at Cleft Centre Peradeniya

Results

Discussion

Conclusion