Ultrasonography - A viable tool for airway assessment

Reddy, Preethi B; Punetha, Pankaj; Chalam, Kolli S

doi:10.4103/0019-5049.193660

Cited by 74 publications

(95 citation statements)

References 16 publications

(24 reference statements)

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“…Therefore results from our study correlates with the work done by Brodsky, et al 11 who stated that neck circumference is a valuable predictor of difficult laryngoscopy in obese patients. Table 7/ Graph 7:-Ezri et al 9 , Wu et al 8 and Reddy et al 10 all showed a similar opinion regarding TMD in their study, stating that TMD is not a reliable screening test for predicting difficult laryngoscopy. Results from our study with regards to TMD favor their opinion as a poor predictor for difficult laryngoscopy (evident from Table7 and Graph 7).…”

Section: Table 6/ Graph 6:-mentioning

confidence: 68%

“…Reddy, et al 10 , also found in their study that modified Mallampati score (≥ 3) is one of the good predictors of difficult intubation with a sensitivity of 71.4 %, specificity of 83.7%…”

Section: Table 5/ Graph 5:-mentioning

confidence: 79%

“…In contrast to their sensitivity of 63.6%, this parameter had the sensitivity of 93.7%. 10 came up with the result that anterior neck soft tissue thickness at the level of vocal cords of > 0.23cm had a sensitivity of 85.7% in predicting a Cormack Lehane Grade III or IV, which was higher than that of modified Mallampati Grade of 3 or 4 denoting difficult laryngoscopy. Whereas in our study anterior neck soft tissue thickness at the level of vocal cords more than 0.92cm was exclusive for difficult laryngoscopy with the sensitivity of around 97%, comparatively higher than modified mallampati scoring.…”

Section: Table 6/ Graph 6:-mentioning

confidence: 99%

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Prediction of Difficult Laryngoscopy by Ultrasound Guided Valuation of Anterior Neck Soft Tissue Thickness.

Kanoujiya¹

2019

IJAR

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Background : The major responsibility of the anaesthesiologist is to provide adequate ventilation to the patient. Most vital element for this is the airway. Difficulties in optimal airway management can lead to serious adverse effects and failure can even lead to mortality. We have evaluated the feasibility of sonography as an imaging tool in identifying important airway anatomical structures on the anterior aspect of the neck and correlated the ultrasound-guided measurements of the airway parameters with the Cormack Lehane classification of the direct laryngoscopy for prediction of the difficult airway. Aim : To predict Difficult Laryngoscopy by Ultrasound guided valuation Of Anterior Neck Soft Tissue Thickness. Method : The study was a prospective observational study. For this study, n (no of cases) =100 considering power of 95% from the previous study; including patients between the age group of 18 to 65 years, ASA I to III grades, scheduled for elective surgery and requiring general anaesthesia with directlaryngoscopy and endotracheal intubation. Patient with anticipated difficult airway were excluded. Modified Mallampati score, Neck circumference at the level of the thyroid cartilage, Thyromental distance, BMI, distance from skin to hyoid bone and distance from skin to the anterior commissure of vocal cords using the USG machine followed by MCLS grade on laryngoscopy were noted. Result : With reference to ROC analysis, the optimal cutoffs of DSHB, DSAC, neck circumference and BMI measurements for the prediction of difficult Laryngoscopy is 0.81 cm, 0.92 cm, 35.75cm and 24.8 kg/m 2 respectively with the area under the curves being 0.944, 0.970, 0.801 and 0.745 respectively. Similarly, the optimal cutoff value for modifiedMallampati grades for the prediction of difficult Laryngoscopy is Grade II and above with area under the curves being 0.718. We also found that with experience the required time to measure the distances using USG was reduced with experience. Conclusion : We conclude from our study that the BMI, modified Mallampati grade and neck circumference are good predictors of

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Section: Table 6/ Graph 6:-mentioning

confidence: 68%

“…Reddy, et al 10 , also found in their study that modified Mallampati score (≥ 3) is one of the good predictors of difficult intubation with a sensitivity of 71.4 %, specificity of 83.7%…”

Section: Table 5/ Graph 5:-mentioning

confidence: 79%

Section: Table 6/ Graph 6:-mentioning

confidence: 99%

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Prediction of Difficult Laryngoscopy by Ultrasound Guided Valuation of Anterior Neck Soft Tissue Thickness.

Kanoujiya¹

2019

IJAR

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“…In the non-obese patients ANS measurements at the levels of the hyoid bone and epiglottis might discriminate between easy and difficult laryngoscopy [15]. Reported sensitivities and specificities for ANS measured at different levels vary considerably among studies [7,12,18,19,22,24]. These clinical studies are not fully comparable and each includes only modest numbers of patients.…”

Section: Anterior Neck Soft Tissue Thicknessmentioning

confidence: 99%

“…US of the upper airway provides detailed anatomic information and has numerous potential clinical applications [5,6]. It can be used to estimate tracheal tube size, confirm correct tracheal tube and laryngeal mask placement, diagnose upper airway pathology, guide percutaneous tracheostomy or cricothyroidotomy and predict post-extubation stridor [7]. The role of US in anesthesia-related airway assessment is encouraging although it is poorly defined.…”

Section: Introductionmentioning

confidence: 99%

Preoperative difficult airway prediction using suprahyoid and infrahyoid ultrasonography derived measurements in anesthesiology

et al. 2019

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Airway management is one of the most important skills in everyday practice of anesthesia. Improper airway management might contribute to significant morbidity and mortality. In some patients, clinical parameters do not anticipate all difficulties related to airway management. Ultrasonography (US) might confer a potential screening tool for difficult airway. Suprahyoid and infrahyoid US measurements have been investigated for difficult airway prediction in anesthesiology. The most extensively investigated parameter was the anterior neck soft tissue thickness measured at different levels: anterior to the hyoid bone, epiglottis and vocal cords commissure. Hyomental distances measured with the head placed in neutral, sniffing or maximal hyperextended position and the derived hyomental distance ratios have also been evaluated for difficult airway prediction. For the evaluation of the tongue, measurements such as thickness, cross-sectional area, width, volume and tongue-to-oral cavityratio can be used. Thus, anesthesiologists have many available potential US measurements, which could provide information regarding airway anatomy during the preoperative airway assessment and could serve as potential screening parameters for difficult airway. Still, we do not yet know which of these provides optimal predictive accuracy and larger sample size studiesare required to validate their use in the preoperative evaluation of the airway.

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Will This Patient Be Difficult to Intubate?

Detsky

Jivraj

Adhikari

et al. 2019

JAMA

152

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IMPORTANCERecognizing patients in whom endotracheal intubation is likely to be difficult can help alert physicians to the need for assistance from a clinician with airway training and having advanced airway management equipment available.OBJECTIVE To identify risk factors and physical findings that predict difficult intubation.DATA SOURCES The databases of MEDLINE and EMBASE were searched from 1946 to June 2018 and from 1947 to June 2018, respectively, and the reference lists from the retrieved articles and previous reviews were searched for additional studies.STUDY SELECTION Sixty-two studies with high (level 1-3) methodological quality that evaluated the accuracy of clinical findings for identifying difficult intubation were reviewed.DATA EXTRACTION AND SYNTHESIS Two authors independently abstracted data. Bivariate random-effects meta-analyses were used to calculate summary positive likelihood ratios across studies or univariate random-effects models when bivariate models failed to converge. RESULTS Among the 62 high-quality studies involving 33 559 patients, 10% (95% CI, 8.2%-12%) of patients were difficult to intubate. The physical examination findings that best predicted a difficult intubation included a grade of class 3 on the upper lip bite test (lower incisors cannot extend to reach the upper lip; positive likelihood ratio, 14 [95% CI, 8.9-22]; specificity, 0.96 [95% CI, 0.93-0.97]), shorter hyomental distance (range of <3-5.5 cm; positive likelihood ratio, 6.4 [95% CI, 4.1-10]; specificity, 0.97 [95% CI, 0.94-0.98]), retrognathia (mandible measuring <9 cm from the angle of the jaw to the tip of the chin or subjectively short; positive likelihood ratio, 6.0 [95% CI, 3.1-11]; specificity, 0.98 [95% CI, 0.90-1.0]), and a combination of physical findings based on the Wilson score (positive likelihood ratio, 9.1 [95% CI, 5.1-16]; specificity, 0.95 [95% CI, 0.90-0.98]). The widely used modified Mallampati score (Ն3) had a positive likelihood ratio of 4.1 (95% CI, 3.0-5.6; specificity, 0.87 [95% CI, 0.81-0.91]).CONCLUSIONS AND RELEVANCE Although several simple clinical findings are useful for predicting a higher likelihood of difficult endotracheal intubation, no clinical finding reliably excludes a difficult intubation. An abnormal upper lip bite test, which is easily assessed by clinicians, raises the probability of difficult intubation from 10% to greater than 60% for the average-risk patient.

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Ultrasonography - A viable tool for airway assessment

Cited by 74 publications

References 16 publications

Prediction of Difficult Laryngoscopy by Ultrasound Guided Valuation of Anterior Neck Soft Tissue Thickness.

Prediction of Difficult Laryngoscopy by Ultrasound Guided Valuation of Anterior Neck Soft Tissue Thickness.

Preoperative difficult airway prediction using suprahyoid and infrahyoid ultrasonography derived measurements in anesthesiology

Will This Patient Be Difficult to Intubate?

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