Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000200005
Brazilian Journal of Anesthesiology
Scientific Article

Intubação difícil em crianças: aplicabilidade do índice de Mallampati

Difficult intubation in children: applicability of the Mallampati index

Ana Paula S Vieira Santos; Ligia Andrade S Telles Mathias; Judymara Lauzi Gozzani; Marcelo Watanabe

http://dx.doi.org/10.1590/S0034-70942011000200005 Braz J Anesthesiol, vol.61, n2, p.159-162, 2011
PDF Português
PDF English
Downloads: 0
Views: 1090

Resumo

JUSTIFICATIVA E OBJETIVOS: A preocupação de estar diante de uma via aérea difícil trouxe à tona a necessidade de se desenvolverem testes preditivos de intubação difícil. Tais testes foram, primariamente, desenvolvidos para populações adultas. Nos pacientes pediátricos, os estudos existentes sempre trataram de pacientes com malformações congênitas, politraumatizados e recém-nascidos. O objetivo deste trabalho foi verificar, em pacientes na faixa etária de 4 a 8 anos, a aplicabilidade do teste preditivo de intubação difícil mais comumente utilizado em adultos, o índice de Mallampati, correlacionando-o com o índice de Cormack-Lehane. MÉTODO: Foram estudados 108 pacientes com idades entre 4 e 8 anos, ASA I, sem quaisquer tipos de malformações anatômicas, síndromes genéticas ou déficits cognitivos. Os pacientes foram submetidos, durante a avaliação pré-anestésica, ao índice de Mallampati. Após a indução anestésica, realizava-se a avaliação do índice de Cormack-Lehane. Nos testes estatísticos p < 0,05, foi considerado significativo. RESULTADOS: O índice de Mallampati apresentou correlação significativa com o índice de Cormack-Lehane. A sensibilidade e a especificidade do índice de Mallampati foram, respectivamente, de 75,8% e 96,2%, mas o intervalo de confiança da sensibilidade foi muito grande. CONCLUSÕES: O índice de Mallampati se mostrou aplicável em crianças de 4 a 8 anos.

Palavras-chave

ANESTESIA, Pediátrica, AVALIAÇÃO, Pré-anestésica, CIRURGIA, Cuidados pré-operatórios, COMPLICAÇÕES, Intubação Endotraqueal, Criança, INTUBAÇÃO TRAQUEAL, TÉCNICAS DE MEDIÇÃO

Abstract

BACKGROUND AND OBJECTIVES: The concern of facing difficult airways brought the need of developing predictive testing for difficult intubation. Those tests were developed primarily for adult populations. In pediatric patients studies always focus on patients with congenital malformation, polytraumatized, and newborns. The objective of the present study was to determine the applicability of the predictive test used more often in adults, the Mallampati index, in patients 4 to 8 years old, correlating it with the Cormack-Lehane index. METHODS: One hundred and eight patients 4 to 8 years of age, ASA I, without any type of congenital malformation, genetic syndromes or cognitive deficits were evaluated. The Mallampati index was applied to patients during the pre-anesthetic evaluation. Evaluation of the Cormack-Lehane index was performed after anesthetic induction. A p < 0.05 was considered significant. RESULTS: The Mallampati index showed a significant correlation with the Cormack-Lehane index. The sensitivity and specificity of the Mallampati index were 75.8% and 96.2% respectively, but the sensitivity showed a wide confidence interval. CONCLUSIONS: The Mallampati index was proven to be applicable in children 4 to 8 years old.

Keywords

Intubation, Intratracheal, Pediatrics, Predictive Value of Tests, Preoperative care

References

Tay CL, Tan GM, Ng SB. Critical incidents in paediatric anesthesia: an audit of 10000 anaesthetics in Singapore. Paediatr Anaesth. 2001;11:711-718.

Training guidelines in anaesthesia of the European Board of Anaesthesiology Reanimation and Intensive Care. Eur J Anaesthesiol. 2001;18:563-571.

Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98:1269-1277.

Frova G, Guarino A. Recommendations for airway control and difficult airway management in paediatric patients. Minerva Anestesiol. 2006;72:723-748.

Reber A. The paediatric upper airway: anaesthetic aspects and conclusions. Curr Opin Anaesthesiol. 2004;17:217-221.

Von Unger-Sternberg BS, Habre W. Pediatric anesthesia: potential risks and their assessment: part I. Pediatr Anesth. 2007;17:206-215.

Koop VJ, Baily A, Valley RD. Utility of the Mallampati classification for predicting difficult intubation in pediatric patients. Anesthesiology. 1995;83A.

Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987;42:487-490.

Shiga T, Wajima Z, Inoue T. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005;103:429-437.

Davidson MC, Amso D, Anderson LC. Development of cognitive control and executive functions from 4 to 13 years: evidence from manipulations of memory, inhibition, and task switching. Neuropsychologia. 2006;44:2037-2078.

Westhorpe RN. The position of the larynx in children and its relationship to the ease of intubation. Anaesth Intensive Care. 1987;15:384-388.

Lee A, Fan LTY, Gin T. A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg. 2006;102:1867-1878.

Bilgin H, Ozyurt G. Screening tests for predicting difficult intubation: A clinical assessment in Turkish patients. Anaesth Intensive Care. 1998;26:382-386.

5dd6d0720e8825456713f287 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections