Preoperative airway ultrasound assessment in the sniffing position: a prospective observational study

Fernández-Vaquero, Miguel Ángel; Charco-Mora, Pedro; García-Aroca, Miguel Ángel; Greif, Robert

doi:10.1016/j.bjane.2022.07.003

Cited by 9 publications

(22 citation statements)

References 29 publications

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“…Among all the ultrasound parameters studied, distance from skin to epiglottis with a cut-off point of 2.10 cm, showed the best predictive ability with a sensitivity of 83.33% and a specificity of 73.33%, for predicting difficulty in airway management in routine clinical practice. This result is similar to various studies and metanalysis reported in the literature ( 11 , 17 , 19 – 26 ). A higher cut-off point of 2.70 cm can be found in other studies ( 27 ).…”

Section: Discussionsupporting

confidence: 92%

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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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Section: Discussionsupporting

confidence: 92%

“…Besides, a strong trend between male gender and DL ( p = 0.0508) has been observed. This finding has also been described in other studies ( 19 , 21 , 25 , 27 , 32 , 33 ). On the other hand, some authors ( 22 – 24 , 34 , 35 ) could not find a statistically significant correlation.…”

Section: Discussionsupporting

confidence: 91%

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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“…Difficult airway assessment tests (such as Mallampati classification [14] ), computer tomography, [15,16] ultrasonography, [17,18] and risk index predictions [19][20][21] were identified as future research trends and hot topics through co-occurrence analysis. These topics were studied frequently (big dot size in co-occurrence network visualization), emerged in recent years (orange color in co-occurrence overlay analysis), and with relative importance (color green and yellow in density analysis).…”

Section: Discussionmentioning

confidence: 99%

“…The United States has the most total times cited (17,202), followed by the United Kingdom (10,350), France (5119), Canada (4877) and Germany (3819).…”

Section: Contribution Of Countriesmentioning

confidence: 99%

Global research trends in prediction of difficult airways: A bibliometric and visualization study

Lian

Pan

et al. 2023

Medicine

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Many tools are used to predict difficult airway, including bedside screening tests, radiological variables, and ultrasonography. However, the “gold standard” to identify difficult airway before intubation has not been established. The assessment and prediction of difficult airway is receiving increasing attention in clinical practice due to the devastating results of failed oxygenation or intubation. A literature visualization study is necessary to understand the research trend and help tailor future research directions. Science citation index-expanded web of Science database were used to search for literature related to assessment and prediction of difficult airways published before May 9th, 2022. VOS viewer software was used for visual analysis, including literature statistics, and co-occurrence analysis. A total of 2609 articles were included. The amount of relevant research interest and literature is increasing every year. According to co-occurrence network analysis, the research results can be grouped into the following 5 clusters, intubation approaches, intubation in special populations, difficult airway assessment tests, intubation in critical care/emergency settings and education, and laryngoscopes. Co-occurrence overlay analysis showed that video laryngoscopes and index prediction (including computed tomography and ultrasonography), emerged recently and comprised an important percentage of current studies. It can be predicted that future studies should focus on understanding the upper airway anatomy and constructing risk index predictions. Based on current global research trends, risk index predictions are the next hot topics in the evaluation and prediction of difficult airways, and video laryngoscopes will continue to be a hot topic in this field.

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“…Ultrasound imaging is a noninvasive, simple, and portable tool that may help clinicians with rapid airway assessment and management in operating rooms, emergency departments, and intensive care units [ 41 ]. Point-of-care ultrasound (POCUS) has emerged as a valuable diagnostic and therapeutic aid for a wide range of procedures, with many studies highlighting its promising role in airway assessment over the last decade [ 42 , 43 , 44 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

Trends in Preoperative Airway Assessment

Marchis,

Negrut,

Blebea

et al. 2024

Diagnostics

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Airway management is a vital part of anesthesia practices, intensive care units, and emergency departments, and a proper pre-operative assessment can guide clinicians’ plans for securing an airway. Complex airway assessment has recently been at the forefront of anesthesia research, with a substantial increase in annual publications during the last 20 years. In this paper, we provide an extensive overview of the literature connected with pre-operative airway evaluation procedures, ranging from essential bedside physical examinations to advanced imaging techniques such as ultrasound (US), radiography, computed tomography (CT), and magnetic resonance imaging (MRI). We discuss transnasal endoscopy, virtual endoscopy, 3D reconstruction-based technologies, and artificial intelligence (AI) as emerging airway evaluation techniques. The management of distorted upper airways associated with head and neck pathology can be challenging due to the intricate anatomy. We present and discuss the role of recent technological advancements in recognizing difficult airways and assisting clinical decision making while highlighting current limitations and pinpointing future research directions.

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Preoperative airway ultrasound assessment in the sniffing position: a prospective observational study

Cited by 9 publications

References 29 publications

A new score for airway assessment using clinical and ultrasound parameters

A new score for airway assessment using clinical and ultrasound parameters

Global research trends in prediction of difficult airways: A bibliometric and visualization study

Trends in Preoperative Airway Assessment

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