Does ultrasonographic volume of the thyroid gland correlate with difficult intubation? An observational study

Meço, Başak Ceyda; Alanoğlu, Zekeriyya; Yılmaz, Ali Abbas; Basaran, Cumhur; Alkış, Neslihan; Demirer, Seher; Cuhruk, Handan

doi:10.1016/j.bjane.2014.06.004

Cited by 10 publications

(12 citation statements)

References 9 publications

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“…Two studies were excluded because of a different definition of difficult direct laryngoscopy, 60 , 61 and 2 studies enrolling pregnant women were excluded. 62 , 63 …”

Section: Resultsmentioning

confidence: 99%

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Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis

Carsetti

Sorbello

Adrario

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Despite several clinical index tests that are currently applied for airway assessment, unpredicted difficult laryngoscopy may still represent a serious problem in anesthesia practice. The aim of this systematic review and meta-analysis was to evaluate whether preoperative airway ultrasound can predict difficult direct laryngoscopy in adult patients undergoing elective surgery under general anesthesia. METHODS: We searched the Medline, Scopus, and Web of Science databases from their inception to December 2020. The population of interest included adults who required tracheal intubation for elective surgery under general anesthesia without clear anatomical abnormalities suggesting difficult laryngoscopy. A bivariate model has been used to assess the accuracy of each ultrasound index test to predict difficult direct laryngoscopy. RESULTS: Fifteen studies have been considered for quantitative analysis of summary receiver operating characteristic (SROC). The sensitivity for distance from skin to epiglottis (DSE), distance from skin to hyoid bone (DSHB), and distance from skin to vocal cords (DSVC) was 0.82 (0.74–0.87), 0.71 (0.58–0.82), and 0.75 (0.62–0.84), respectively. The specificity for DSE, DSHB, and DSVC was 0.79 (0.70–0.87), 0.71 (0.57–0.82), and 0.72 (0.45–0.89), respectively. The area under the curve (AUC) for DSE, DSHB, DSVC, and ratio between the depth of the pre-epiglottic space and the distance from the epiglottis to the vocal cords (Pre-E/E-VC) was 0.87 (0.84–0.90), 0.77 (0.73–0.81), 0.78 (0.74–0.81), and 0.71 (0.67–0.75), respectively. Patients with difficult direct laryngoscopy have higher DSE, DSVC, and DSHB values than patients with easy laryngoscopy, with a mean difference of 0.38 cm (95% confidence interval [CI], 0.17–0.58 cm; P = .0004), 0.18 cm (95% CI, 0.01–0.35 cm; P = .04), and 0.23 cm (95% CI, 0.08–0.39 cm; P = .004), respectively. CONCLUSIONS: Our study demonstrates that airway ultrasound index tests are significantly different between patients with easy versus difficult direct laryngoscopy, and the DSE is the most studied index test in literature to predict difficult direct laryngoscopy. However, it is not currently possible to reach a definitive conclusion. Further studies are needed with better standardization of ultrasound assessment to limit all possible sources of heterogeneity.

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“…Two studies were excluded because of a different definition of difficult direct laryngoscopy, 60 , 61 and 2 studies enrolling pregnant women were excluded. 62 , 63 …”

Section: Resultsmentioning

confidence: 99%

“…Two studies were excluded because of a different definition of difficult direct laryngoscopy, 60,61 and 2 studies enrolling pregnant women were excluded. 62,63 Risk of Bias and Quality of Evidence The quality assessment of the studies is summarized in Table 1.…”

Section: Excluded Studiesmentioning

confidence: 99%

Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis

Carsetti

Sorbello

Adrario

et al. 2022

Anesthesia &Amp; Analgesia

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“…Thyroid gland disease also contributes to NC enlargement and DTI. Thyroid gland volume is not correlated with DTI [17], However, goiter (OR [95%CI]: 2.513 [1.139–5.542], p = 0.022) and thyroid weight (OR [95%CI]: 2.232 [1.075–4.636], p = 0.031) are independent risk factors for DTI in thyroid surgery patients [18]. Consistent with our results, invasion and infiltration of adjacent tissues by thyroid gland disease, more than expansion of thyroid gland volume, affects the neck and predicts DTI in patients undergoing thyroid surgery [17].…”

Section: Discussionmentioning

confidence: 99%

Prediction of difficult tracheal intubations in thyroid surgery. Predictive value of neck circumference to thyromental distance ratio

et al. 2019

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Introduction Difficult tracheal intubation (DTI) contributes to perioperative morbidity and mortality. There are conflicting study results about the most predictive DTI risk criteria in patients undergoing thyroid surgery. Materials and methods We conducted a prospective observational study on 500 consecutive patients aged ≥18 years to identify predictors for DTI. Body weight, body mass index (BMI), inability to prognath, head movement, mouth opening, Mallampati score, neck circumference (NC), thyromental distance (TMD), neck circumference to thyromental distance ratio (NC/TMD), tracheal deviation apparent on chest x-ray, mediastinal goiter, histology and history of DTI were measured as possible predictors of DTI. Spearman's rank correlation test and multiple logistic regression analysis were performed. Results DTI was observed in 9.6% of all patients. Compared with the group of patients without DTI, the group of patients with DTI had significantly greater median values for body weight, BMI, NC, NC/TMD, Mallampati score, el-Ganzouri score, incidence of mediastinal goiter, and had reduced TMD and mouth opening. Significant correlations between BMI ≥30 kg/m 2 and the Mallampati score ≥3 (R = 0.124, p = 0.00541), Cormack-Lehane ≥3 (R = 0.128, p = 0.00409), NC ≥40 cm (R = 0.376, p<0.001), and NC/TMD ≥5 (R = 0.103, p = 0.0207) were found. The logistic regression analysis revealed that an NC ≥40 cm at the goiter level, but not an NC/TMD ratio ≥5, was the strongest predictor of DTI (p<0.001). The area under the receiver operating characteristic curve for NC/TMD was better than the curve for NC. The sensitivity and specificity of NC/TMD were also greater, compared with NC. An NC of 40.00 cm and an NC/TMD of 5.85 were the estimated cut-off points. Discussion This study found that NC was a strong predictor of DTI. The results also suggested that NC/TMD could be used as a measure to stratify the risk of DTI in patients undergoing thyroid surgery.

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“…Tracheal compression was defined by the maximum percentage of reduction in tracheal diameter. The degree of tracheal compression was assigned using the Cotton classification system [20] by 3 blinded authors independently (H.Z., M.J.O., or N.L.L.). The size of an obstructed airway was determined at its smallest point.…”

Section: Methodsmentioning

confidence: 99%

Can Thyroid Ultrasonography Predict Substernal Extension or Tracheal Compression in Goiters?

et al. 2018

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Purpose To determine whether an ultrasonography (US)-defined thyroid volume can accurately predict substernal extension or tracheal narrowing. Methods After research ethics approval, we identified patients with thyroid nodules investigated with both US and computed tomography (CT). Reviewers assigned scores for both substernal extension and tracheal compression on CT using pre-established classification systems. Statistical analysis with receiver operating characteristic curve analysis was performed to find the US-determined thyroid volume thresholds that correlated with each substernal extension and tracheal compression. Results This study included 120 patients (mean age 63.4 years; SD ± 15.9; 67% female). Thirty-five patients (29%) had substernal extension. The mean US total thyroid gland volume in patients with and without substernal extension were 92.4 and 37.6 cm3, respectively ( P < .001). 86% of patients with substernal extension had tracheal narrowing vs. 27% of patients without substernal extension ( P < .0001). A cutoff dominant gland volume of ≥37.5 cm3 showed 83% sensitivity and 79% specificity for substernal extension (area under the curve [AUC] = 0.84). A total thyroid gland volume threshold of ≥37.8 cm3 showed 89% sensitivity and 87% specificity for any degree of tracheal narrowing (AUC = 0.90). Conclusions This study suggests that US volumes may be used as a predictor to identify those patients with thyroid enlargement who are most at risk of substernal extension and tracheal compression and who may benefit from preoperative CT imaging for optimal surgical and anesthetic planning.

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Does ultrasonographic volume of the thyroid gland correlate with difficult intubation? An observational study

Cited by 10 publications

References 9 publications

Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis

Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis

Prediction of difficult tracheal intubations in thyroid surgery. Predictive value of neck circumference to thyromental distance ratio

Can Thyroid Ultrasonography Predict Substernal Extension or Tracheal Compression in Goiters?

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