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, R2 = .208, P = .000) and also between upper incisor‐carina length and the height of the patient (R = .528, R2 = .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.