Sonographic predictors may help identify patients with difficult laryngoscopy. Individual measures have unsatisfactory diagnostic profiles. The models based on combined tests have improved diagnostic value.

Sonography allows bedside measurements of the hyomental distance ratio and tongue size in morbidly obese patients. Preoperative assessment of the hyomental distance ratio may predict difficult laryngoscopy resulting in difficult intubation.

This study was performed to determine whether hypoxia in glucose-free solutions can increase the electrical resistance of intercellular junctions in ventricular muscle. Internal longitudinal resistance (Ri), mechanical tension, and transmembrane action potentials were measured simultaneously in cow ventricular trabeculae. The mean control value of Ri was 265 +/- 38 omegacm (mean +/- SE) at 34 degrees C. After 1 hour of hypoxia in glucose-free Tyrode's solution, it had increased by 300 +/- 41% (n = 11, P less than 0.001). The rise in Ri was closely related to the increase in resting tension (contracture). These effects were more pronounced during a second exposure to hypoxia and were potentiated by application of epinephrine, by increasing extracellular calcium concentration, and by increasing frequency of stimulation. Addition of glucose (50 mM) provided some protection against hypoxia. It is inferred that the increase in Ri is entirely due to the increase in the resistance of intercellular junctions (electrical uncoupling). Intracellular calcium may be responsible for both the contracture and the uncoupling.

To assess the degree to which cricoid pressure (Sellick manoeuvre) actually compresses the oesophagus, we measured the effect of cricoid pressure and paralaryngeal pressure on the outer anteroposterior diameter of the upper oesophagus with ultrasound in 39 healthy volunteers. The mean (SD) outer anteroposterior oesophageal diameter was 0.77 (0.11) cm with no pressure, 0.79 (0.13) cm with the application of cricoid pressure of 30 N and 0.68 (0.12) cm with the application of paralaryngeal pressure of 30 N (p < 0.0001). If cricoid pressure does not reduce the anteroposterior diameter of the oesophagus, it is difficult or impossible to explain the efficacy of the Sellick manoeuvre. However, paralaryngeal pressure decreases this diameter and has the potential to occlude the upper oesophagus.

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