A comparison of airway dimensions, measured by acoustic reflectometry and ultrasound before and after general anaesthesia

Ushiroda, Junko; Inoue, Satoki; Kirita, Tadaaki; Kawaguchi, Masahiko

doi:10.1111/anae.12825

Cited by 5 publications

(8 citation statements)

References 31 publications

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“…In the present study, maximum airway deterioration was seen at the first assessment, i.e., one hour postoperatively. Similar to our findings, some researchers observed maximum airway deterioration in the immediate postoperative period [5,6]. While in another study, maximum postoperative airway edema was recorded at four hours in 86.4% of patients and eight hours in rest 13.6% of patients [3].…”

Section: Discussionsupporting

confidence: 91%

“…We also observed airway deterioration in most of our patients (92%) in the immediate postoperative period post-extubation but we could not assess the actual increase in intubation difficulty as none of our patients required reintubation in the postoperative period. Similar airway changes were observed by various authors postoperatively and during labor/delivery although the incidence varies [3][4][5][6]11]. There is a discrepancy among different studies regarding the time for maximum airway changes seen.…”

Section: Discussionsupporting

confidence: 73%

“…But both of these authors could not identify any factor that could predict the persistence of airway changes after 48 hours. Other researchers in their studies did not follow the persistence of these airway changes [5,6].…”

Section: Discussionmentioning

confidence: 96%

“…Various studies evaluated the development of airway edema during surgeries or labor [4,5]. But very few had studied airway deterioration during prone position surgeries and their regression back to a preoperative state [3,6].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Study to Evaluate Changes in Modified Mallampati Class in Patients Undergoing Spine Surgery in Prone Position

Jain¹,

Lal²,

Aggrawal³

et al. 2022

Cureus

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Background: Perioperative airway changes due to anesthesia and surgery could change a normal airway at induction to a risky airway at extubation.Objectives: The objective is to evaluate primarily the degree of airway changes, as quantified by the modified Mallampati (MMP) class, after spine surgery in the prone position. Secondary to assess the time required for these changes to revert back to the preoperative state and their correlation with other demographic and surgical variables.Methods: The present prospective observational study was conducted in a tertiary care hospital after ethical approval and trial registration. Fifty ASA I and II patients aged 18-65 years of both sex and undergoing spine surgery in prone positions were included. Supine MMP grade was observed preoperatively and at one, two, four, 24, and 48 hours postoperatively.Statistical analysis: IBM SPSS version 22 (IBM Corp, Armonk, NY) was used. Mean values were compared using paired t-tests and medians by the Wilcoxon test. The Spearman correlation was used to assess a relationship. The time for recovery was analyzed by Kaplan-Meir analysis.Results: An increase in MMP grade was observed at one hour postoperatively in 46 (92%) patients. Changes reverted back in 45 (98%) patients by 24 hours postoperatively. A weak positive correlation with age, weight, body mass index, duration of surgery, perioperative drop in hemoglobin, and a moderate positive correlation with fluid administered and estimated blood loss was recorded.Conclusions: An increase in postoperative MMP occurs in the majority of patients undergoing prone position spine surgery which may persist up to 48 hours. So, more vigilance and caution are warranted should reintubation be needed postoperatively.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Study to Evaluate Changes in Modified Mallampati Class in Patients Undergoing Spine Surgery in Prone Position

Jain¹,

Lal²,

Aggrawal³

et al. 2022

Cureus

View full text Add to dashboard Cite

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“…Frequent causes in ICU include: obesity and obstructive sleep apnoea ; major head and neck surgery and following cervical spine surgery or trauma . These problems are compounded by persistent sedation, respiratory depression, residual muscle paralysis, pharyngeal oedema or vocal cord dysfunction .…”

Section: Resultsmentioning

confidence: 99%

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

et al. 2016

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Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a particularly vulnerable time for the critically ill patient and, because of the risks involved and the consequences of failure, it warrants specific consideration. The Royal College of Anaesthetists 4th National Audit Project highlighted differences in the incidence and consequences of major complications during airway management between the operating room and the critical care environment. The findings in the section on Intensive Care and Emergency Medicine reinforce the importance of good airway management in the critical care environment and, in particular, the need for appropriate guidelines to improve patient safety. This narrative review focuses on strategies for safe extubation of the trachea for patients with potentially difficult upper airway problems in the intensive care unit.

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Changes in airway dimensions after robot assisted surgeries in steep Trendelenburg position

Reddy

Jain

et al. 2018

J Robotic Surg

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Robotic surgeries in the extreme Trendelenburg position can lead to changes in the airway dimensions. We conducted a prospective, observational trial to explore the use of ultrasound to quantify these changes in the airway dimensions and identify the factors associated with it. Fifty-two American society of Anaesthesiologists physical status I-II patients between 18 and 70 years of age of either sex scheduled to undergo robot assisted urological procedures in steep Trendelenburg position were enrolled. Anterior soft tissue thickness at the level of hyoid bone and vocal cords, tongue thickness, Malampatti grading and neck circumference were measured at predefined postoperative intervals in the immediate postoperative period, at 2-, 6- and 12-h period postoperatively. Linear stepwise regression analysis was done to explore the factors associated with change in anterior tissue thickness immediately after surgery. The mean difference (95%; CI) in the anterior soft tissue thickness in the immediate postoperative period at the level of hyoid was 0.023 (0.029-0.016) cm, p < 0.001 and at level of vocal cords was - 0.012 (- 0.017 to - 0.008) cm, p < 0.001 from the baseline. There was a significant increase in tongue thickness (0.002), Mallampati score (p = 0.002) and neck circumference (p < 0.001) in immediate postoperative period. The change in anterior tissue thickness at the level of hyoid was affected by total intraoperative fluids used (r = 0.602, p < 0.001), airway trauma (r = 0.275, p = 0.002) and duration of surgery (r = 0.243, p = 0.025). Significant changes in airway dimensions after robotic surgeries in Trendelenburg position persist till 2 h in the postoperative period which warrant vigilant monitoring for any airway compromise during this period.

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A comparison of airway dimensions, measured by acoustic reflectometry and ultrasound before and after general anaesthesia

Cited by 5 publications

References 31 publications

A Study to Evaluate Changes in Modified Mallampati Class in Patients Undergoing Spine Surgery in Prone Position

A Study to Evaluate Changes in Modified Mallampati Class in Patients Undergoing Spine Surgery in Prone Position

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

Changes in airway dimensions after robot assisted surgeries in steep Trendelenburg position

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