Accuracy of Preoperative Ultrasonographic Airway Assessment in Predicting Difficult Laryngoscopies in Adult Patients

Bhagavan, Sinchana; Nelamangala, Kiran

doi:10.7759/cureus.35652

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…They concluded that both have very strong statistical significance, and DSHB seemed to have a better diagnostic value for predicting a difficult airway in their study. [ 7 ] We found similar results; however, we measured distances at the hyoid bone and thyroid isthmus levels. Both were more in the difficult laryngoscopy group, with DSTI being a better predictor of a difficult airway.…”

Section: Discussionsupporting

confidence: 69%

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Prediction of the difficult airway by pre-operative ultrasound-based measurement of airway parameters: A prospective observational study

Waindeskar,

Padala,

Jain

et al. 2023

Indian Journal of Anaesthesia

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Background and Aims: Ultrasonography has emerged as a new airway assessment tool. However, its role in predicting difficult airways needs to be explored. This study aimed to evaluate the accuracy of pre-operative ultrasound assessment of the neck in predicting difficult airways in patients undergoing elective surgery under general anaesthesia. Methods: One hundred and fourteen adult patients undergoing elective surgeries under general anaesthesia were enrolled in this study. In the pre-operative room, upper airway ultrasound measurements of the neck were obtained, namely, distance from skin to the hyoid bone, distance from skin to the thyroid isthmus and thickness of the base of the tongue. Clinical airway assessment details were noted from the pre-anaesthetic evaluation form. The airway management technique was noted. Receiver operating characteristic curves were used to assess the diagnostic value of these upper airway ultrasound measurements in predicting difficult airways. Results: The distance from the skin to the thyroid isthmus in the difficult airway group (0.37 ± 0.133 cm) was significantly higher than in the non-difficult group (P = 0.007). It appeared to be a better predictor of difficult airways and correlated better with clinical tests among the measured ultrasound parameters. The body mass index was significantly higher in the difficult airway group (P = 0.009). Conclusion: Considering the difference in means between the two groups, distance from the skin to the thyroid isthmus should be explored as a potential predictor of a difficult airway in studies with a larger sample size.

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Section: Discussionsupporting

confidence: 69%

“…[ 4 5 6 ] Pre-operative ultrasound measurement of the anterior neck soft-tissue thickness at various levels, in combination with the standard screening tests and assessment tools for difficult laryngoscopy, may enhance the prediction of difficult laryngoscopy. [ 7 8 ]…”

Section: Introductionmentioning

confidence: 99%

Prediction of the difficult airway by pre-operative ultrasound-based measurement of airway parameters: A prospective observational study

Waindeskar,

Padala,

Jain

et al. 2023

Indian Journal of Anaesthesia

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“…Bhagavan et al [9] performed a pre-anesthetic ultrasound airway assessment. They concluded that distance from skin to epiglottis midway (DSEM)-thickness of anterior neck soft tissue in the transverse view at the level of the thyrohyoid membrane with a cut-off at 2.03 cm correlated positively with difficult laryngoscopy.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Ultrasound Parameters and Clinical Parameters in Airway Assessment for Prediction of Difficult Laryngoscopy and Intubation: An Observational Study

Udayakumar¹,

Priya²,

Narayanan³

2023

Cureus

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Background and objectiveThe primary responsibility of the anesthesiologist is to provide adequate oxygenation and ventilation to the patient by securing the airway. Prediction of Cormack-Lehane (CL) grading preoperatively helps patients' airway management during anesthesia induction, particularly in difficult intubations. Our study aims to evaluate airway assessment modalities using ultrasound and conventional clinical screening methods for predicting difficult laryngoscopy and intubation. Materials and methodsThis prospective observational study was conducted on 100 patients aged between 18 and 70 years belonging to ASA classes I, II, and III scheduled for elective surgery requiring general anesthesia under endotracheal intubation was included in the study. Patients who needed rapid sequence induction and had a history of difficult intubation, obese patients with a body mass index (BMI) of more than 40, patients with notable swelling in the neck region (thyroid), pregnant patients, and patients with maxillofacial anomalies were excluded from the study. Clinical parameters such as body mass index, neck circumference, modified Mallampati grading, thyromental distance, and ultrasound parameters such as anterior neck soft tissue thickness at the level of the thyrohyoid membrane (ANS-TM) and anterior neck soft tissue thickness at the level of vocal cord (ANS-VC) were obtained preoperatively. After intubation, the CL grading was noted and categorized into two groups: easy (classes 1 and 2) and difficult (classes 3 and 4). Descriptive statistics included frequency and percentage for categorical variables and mean±standard deviation for continuous variables. The chi-square test was applied to find the relationship between easy and difficult laryngoscopy when compared with the outcome for categorical variables. A P value of less than 0.05 was considered significant throughout the study. The receiver operating characteristics curve (ROC curve) was used to determine the sensitivity and specificity to predict the outcomes. ResultsUltrasound-guided measurements of ANS-TM and ANS-VC are independent predictors of difficult laryngoscopy compared with clinical screening tests. Of the two parameters, we found that ANS-TM has a better diagnostic value for predicting a difficult airway with an area under the ROC curve (AUC) of 91% compared with ANS-VC, which has an AUC of 84%. Of the clinical parameters, the modified Mallampati grading has an AUC of 81%, leading to better diagnostic value in the prediction of a difficult airway. ConclusionOur study demonstrated that ANS-TM and ANS-VC are independent predictors of a difficult airway. ANS-TM has a better correlation with CL grading. Clinical screening tests should be combined with ultrasound measurements to aid in the better prediction of difficult laryngoscopy.

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A new score for airway assessment using clinical and ultrasound parameters

De Luis-Cabezón,

Ly-Liu,

Renedo-Corcostegui

et al. 2024

Front. Med.

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BackgroundOver the last few years, ultrasonography has been introduced as the fifth pillar to patient’s bedside physical examination. Clinical assessments aim to screen and look for airway difficulties to predict difficult intubations, but none have demonstrated a significant predictive capacity. Recent systematic reviews have established a correlation between ultrasound imaging and difficult direct laryngoscopy. The primary objective of this study was to determine whether the utilization of ultrasonography to examine the upper airway could accurately predict difficult direct laryngoscopy.MethodsThis is a prospective observational study including 102 adult patients that required general anesthesia for elective surgery. Preoperatively, clinical airway assessments were performed. Data such as Mallampati-Samsoon grade (MS), upper lip bite test (ULBT), thyromental (TMD) and sternomental distance (SMD), cervical circumference (CC) and the Arné risk index were collected. Ultrasound evaluation was taken at five different levels in two planes, parasagittal and transverse. Therefore, the following measurements were registered: distance from skin to hyoid bone (DSHB), distance from skin to thyrohyoid membrane (DSTHM), distance from skin to epiglottis (DSE), distance from skin to thyroid cartilage (DSTC) and distance from hyoid bone and thyroid cartilage (DHBTC). Patients were divided into two groups based on the difficulty to perform direct laryngoscopy, according to Cormack-Lehane (C-L) classification. Grades I and II were classified as easy laryngoscopy and grades III or IV as difficult. Logistic regression models and the Receiver Operating Characteristic (ROC) curve was employed to determine the diagnostic precision of ultrasound measurements to distinguish difficult laryngoscopy (DL).ResultsThe following risk score for DL was obtained, DSTHM ≥ 1.60 cm (2 points), DSTC ≥ 0.78 cm (3 points) and gender (2 points for males). The score can range from 0 to 7 points, and showed and AUC (95% CI) of 0.84 (0.74–0.95). A score of 5 points or higher indicates a 34-fold increase in the risk of finding DL (p = 0.0010), sensitivity of 91.67, specificity of 75.56, positive predictive value of 33.33, and negative predictive value of 98.55.ConclusionThe use of ultrasonography combined with classic clinical screening tests are useful tools to predict difficult direct laryngoscopy.

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Accuracy of Preoperative Ultrasonographic Airway Assessment in Predicting Difficult Laryngoscopies in Adult Patients

Cited by 4 publications

References 13 publications

Prediction of the difficult airway by pre-operative ultrasound-based measurement of airway parameters: A prospective observational study

Prediction of the difficult airway by pre-operative ultrasound-based measurement of airway parameters: A prospective observational study

Comparison of Ultrasound Parameters and Clinical Parameters in Airway Assessment for Prediction of Difficult Laryngoscopy and Intubation: An Observational Study

A new score for airway assessment using clinical and ultrasound parameters

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