Preventing inadvertent Endobronchial intubation: Upper incisor to manubriosternal joint length as a predictor of airway length in children.

Background: Malpositioning of the endotracheal tube within the airway can lead to serious complications. The estimated insertion depth of the endotracheal tube should be accurate and reliable.

Aims And Objectives: To study whether the upper incisor-manubriosternal joint length in the extended head position can be used as a predictor of airway length to guide the depth of insertion of endotracheal tube in children and to evaluate the correlation of upper incisor-manubriosternal joint length with the upper incisor-carina length in the neutral head position, in Indian pediatric population.

Materials And Methods: After induction of anesthesia, upper incisor-manubriosternal joint length was measured using a flexible metallic tape. Endotracheal tube was inserted and secured in the midline over the upper incisors. The degree of the maximum head extension was recorded with a goniometer, and the upper incisor-carina length was measured with the help of a fiberoptic bronchoscope.

Results: Analysis revealed a positive correlation between upper incisor-carina length and upper incisor-manubriosternal joint length (R = .456, R  = .208, P = .000) and also between upper incisor-carina length and the height of the patient (R = .528, R  = .279, P-value .000). The degree of maximum head extension did not influence the upper incisor-carina length and the upper incisor-manubriosternal joint length relationship.

Conclusion: The upper incisor-carina length shows a positive correlation with the patient's upper incisor-manubriosternal joint length and the patient's standing height, while the degree of maximum head extension has no significant bearing on this relationship. The upper incisor-manubriosternal joint length can be used as a predictor of airway length and the depth of insertion of endotracheal tube in children.