Predicting difficult laryngoscopy using ultrasound measurement of distance from skin to epiglottis

Pinto, João Odilo Gonçalves; Cordeiro, L.; Pereira, Carlos; Gama, Ricardo; Fernandes, Hugo L.; Assunção, José Pedro

doi:10.1016/j.jcrc.2016.01.029

Cited by 81 publications

(100 citation statements)

References 27 publications

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“…However, data on the impact of US use in airway management remain limited [14]. In the non-obese population, the ultrasonographic measurements of the distance from skin to epiglottis, the ability or inability to visualise the hyoid bone by performing sublingual sonography, and tongue thickness, have been correlated with Cormack-Lehane scores [15][16][17][18][19][20]. Similarly, in the obese population, the pretracheal soft tissue thickness has been linked to difficult airway [21].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-based assessment of hyomental distances in neutral, ramped, and maximum hyperextended positions, and derived ratios, for the prediction of difficult airway in the obese population: a pilot diagnostic accuracy study

Petrișor

Szabó

Constantinescu³

et al. 2018

Anaesthesiol Intensive Ther

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Background: Ultrasonography-assessed hyomental distance (HMD) ratio has been found to discriminate between obese patients with Cormack-Lehane grades 1 or 2 vs. those with grades 3 or 4. The aim of our study is to evaluate the performance of the HMD evaluated ultrasonographically in neutral, ramped, and maximum hyperextended positions, as well as for the ratios obtained by dividing the HMD in the ramped position to that in the neutral position (HMDR1) and by dividing the HMD in maximum hyperextension to that in the neutral position (HMDR2), in order to predict the occurrence of Cormack-Lehane grades 3 or 4 during direct laryngoscopy. Methods: Ultrasound measurements were performed preoperatively in 25 patients with morbid obesity, measuring the HMD in the neutral, ramped, and maximum hyperextended positions. Pre-epyglotic soft tissue thickness, Mallampati and upper lip bite test scores were recorded. Cormack-Lehane grading was considered as an outcome variable in the Receiver Operating Characteristics curve analysis. Results: HMD in the neutral, ramped and maximum hyperextended positions presented similar sensitivities, 100% [39.8-100.0]. For HMD, specificity was 42.86% [21.8-66.0] in the neutral position, 61.9% [38.4-81.9] in the ramped postion, and 71. 4% [47.8-88.7] in the maximum hyperextended position. For HMDR1, the cut-off value was 1.12. This threshold provides 75% [19.4-99.4] sensitivity and 76. 2% [52.8-91.8] specificity. For HMDR2, a cut-off value of 1.23 provides 100% [39.8-100.0] sensitivity and 90.5% [69.6-98.8] specificity. Conclusion: HMDR2 seems to have superior diagnostic accuracy in predicting difficult laryngoscopy in the obese population compared to HMDR1, as well as compared to the HMD in the neutral, ramped, and maximum hyperextended positions.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-based assessment of hyomental distances in neutral, ramped, and maximum hyperextended positions, and derived ratios, for the prediction of difficult airway in the obese population: a pilot diagnostic accuracy study

Petrișor

Szabó

Constantinescu³

et al. 2018

Anaesthesiol Intensive Ther

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“…Pinto et al 23 evaluated the use of the ultrasound-measured distance from the skin to epiglottis in the transverse plane and demonstrated that a cutoff value of 2.75 cm was effective for classifying easy vs difficult laryngoscopies. Falcetta et al 24 also measured this same distance and found that a cutoff value of 2.54 cm was the most effective.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound measurement of laryngeal structures in the parasagittal plane for the prediction of difficult laryngoscopies in Chinese adults

Guan

et al. 2019

Preprint

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Background: Abnormal laryngeal structures are likely to be associated with a difficult laryngoscopy procedure. Currently, laryngeal structures can be measured by ultrasonography, however, little research has been performed on the potential role of ultrasound on the evaluation of a difficult laryngoscopy. The present study investigated the value of laryngeal structure measurements for predicting a difficult laryngoscopy. Objective: The main objective of this study was to explore the value of laryngeal structure measurements for predicting a difficult laryngoscopy. Methods: Two hundred and eleven adult patients (over 18 years old) were recruited to undergo elective surgery under general anesthesia via endotracheal intubation. Ultrasound was utilized to measure the distance between the skin and thyroid cartilage (DST), the distance between the thyroid cartilage and epiglottis (DTE), and the distance between the skin and epiglottis (DSE) in the parasagittal plane. These metrics were then investigated as predictors for classifying a laryngoscopy as difficult vs easy, as defined by the Cormack and Lehane grading scale. Results: Multivariate logistic regression showed that the DSE, but not DST or DTE, was significantly related to difficult laryngoscopies. Specifically, a DSE ≥ 2.36 cm predicted difficult laryngoscopies with a sensitivity and specificity of 0.818 (95% CI: 0.766-0.870) and 0.856 (95% CI: 0.809-0.904). Furthermore, when combining the best model constructed of other indicators (i.e. sex, body mass index, modified Mallampati test) to predict the difficult laryngoscopy, the AUC reached 93.28%. Conclusion: DSE is an independent predictor of a difficult laryngoscopy; a DSE cutoff value of 2.36 cm is a better predictor of a difficult laryngoscope than other ultrasound or physiological measurements for predicting a difficult laryngoscope. Nevertheless, it's more valuable to apply the best model of this study, composed of various physiological measurements, for this prediction purpose. Key words: difficult airway ;endotracheal intubation ; ultrasound

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“…Specific predictors for USG assessments of airway have not yet been established and there is a need for standardized USG scan measures for preoperative airway assessments. The cut off value of 27.5mm for difficult laryngoscopy was considered as the reference value for the current study in which soft tissue thickness was measured with USG between the skin and the epiglottis at the level of the thyroid membrane in elective patients [9]. In this study, no difficulties were encountered in any of the pregnant patients during DSE measurements.…”

Section: Discussionmentioning

confidence: 99%

“…The borders of the epiglottis were delineated by the brighter linear air-mucosa (A-M) interface (posterior) and pre-epiglottic space (anterior). DSE values were calculated with three measurements (central axis and the leftright extremities of the epiglottis) obtained from each patient and the mean value was used in the analysis [9].…”

Section: Methodsmentioning

confidence: 99%

“…In addition to these factors, weight gain above the physiological limits may cause differences in airway evaluation with USG. Pinto et al [9] reported that measuring the distance of the skin-to epiglottis (DSE) was a bedside test that could be used to estimate difficult laryngoscopy, and a cutoff value of 27.5mm provided an accuracy, sensitivity and specificity of 74.3%, 64.7% and 77.1%, respectively.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The measurement of skin to epiglottis length for difficult airway prediction by ultrasonography in obese pregnant women: Prospective cohort study

Kantekin¹,

Erkoç²,

Talih³

2019

Journal of Surgery and Medicine

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Predicting difficult laryngoscopy using ultrasound measurement of distance from skin to epiglottis

Cited by 81 publications

References 27 publications

Ultrasound-based assessment of hyomental distances in neutral, ramped, and maximum hyperextended positions, and derived ratios, for the prediction of difficult airway in the obese population: a pilot diagnostic accuracy study

Ultrasound-based assessment of hyomental distances in neutral, ramped, and maximum hyperextended positions, and derived ratios, for the prediction of difficult airway in the obese population: a pilot diagnostic accuracy study

Ultrasound measurement of laryngeal structures in the parasagittal plane for the prediction of difficult laryngoscopies in Chinese adults

The measurement of skin to epiglottis length for difficult airway prediction by ultrasonography in obese pregnant women: Prospective cohort study

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