PRIMARY OBJECTIVE:To determine the utility of ultrasonographic measurements of tongue width, tongue thickness, tonsil size, hyo-mental distance and thyrohyoid distance of pediatric patients in predicting difficult intubation.

SECONDARY OBJECTIVE:

1.     To determine the predictive value of these ultrasonographic measurements in determination of optimal endotracheal tube size.

2.     To examine the association between these ultrasonographic measurements and airway clinical screening tests (interincisor gap, Mallampati grade and thyromental distance).

Examination of the airway is the most essential component of such preoperative evaluation, from an anaesthesiologist’s point of view. Difficulties in airway management largely contribute to increased mortality and morbidity for the patient. 

Classically employed methods for airway examination include measurement of inter-incisor distance and thyromental distance, estimation of Mallampati grade and assessment of the degree of neck flexion and extension. These tests are of limited use in evaluation of the pediatric airway owing to difference in anatomy of the pediatric airway when compared to that of an adult and, failure to obtain a child’s cooperation in performing these tests. A study done by Kopp et al showed that Mallampati score is a poor predictor of difficult laryngoscopy in paediatric patients.

Though multiple parameters exist for examination of the adult airway, there is limited data on methods to assess the pediatric airway. Thus, relevant, simple and non-invasive methods to evaluate pediatric airway are required to accurately assess the patient’s airway pre-operatively and decrease the occurrence of unanticipated difficult airway intraoperatively.