Is Airway-Related Pathology the Main Risk Factor for Difficult Intubation in Children Under 6 Years Old?

Introduction: Evaluating pediatric airways is challenging, particularly in identifying those at risk for difficult intubation, which is often linked to craniofacial malformations. Limited cooperation from preschoolers further complicates this evaluation.

Objective: To evaluate the predictive accuracy of the Arné Score in identifying risk factors for difficult intubation in preschool-aged children (under 6 y) and develop a model to prevent difficult laryngoscopy and intubation. Secondary objectives include determining the incidence of difficult intubation and the appropriate age for preanesthetic airway assessments.

Methods: This retrospective observational study analyzed 1385 patients aged 0 to 16 years, all undergoing general anesthesia and tracheal intubation in 2018 at a tertiary hospital in Barcelona. Among them, 708 were under 6 years. Predictive tests included the Arné Score, with difficult intubation defined by Cormack-Lehane scores, intubation attempts, and alternative device use. Logistic regression analyzed predictors with significant odds ratios.

Results: Unrecorded Mallampati test values were common in children under 6 years (99.04%). Of those without a history, 8.07% faced intubation difficulties, compared with 50% with a history. Relative risk was 6.23, and the odds ratio was 11.46. Among 202 classified with airway difficulties, 82.67% had no intubation issues. Statistically significant associations highlighted greater risks for those with a difficult intubation history.

Conclusions: Arné Score tests are impractical for children under 6. If no history or airway pathology exists, there's a 95.14% chance of successful intubation. The history of difficult intubation increases risks more than airway pathology alone.