Utility of ultrasonography in preanaesthetic airway assessment

Reddy, Anupama; Aasim, Syed Ali; Satya, Karthik; Prasad, Rajendra

doi:10.21276/apjhs.2017.4.2.14

Cited by 6 publications

(6 citation statements)

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“…In our study value of mean(cm) PES/E-VC were 2.10,2.00 for CL grade 1,2,and 2.46, 2.82 for CL grade 3,4 whereas Reddy et al [21] mean were 1.22,1.25,1.38 for CL grade 1, 2 ,3 not encounter patientsCLwith grade 4.…”

Section: Discussion:-contrasting

confidence: 49%

Use of Ultrasound Parameters for Prediction of Difficult Intubation and Its Relation With the Cormack and Lehane Grade of Laryngoscopy

Dhaka¹,

Meena²,

Bansal³

et al. 2021

IJAR

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Background and AIMS: Airway ultrasound is novel,safe and noninvasive modality that help in predicting difficult airway.This study aimed todetermine the usefulness of airway ultrasound in order to predict difficult intubation. Method:- This was a hospital based prospective observational study on 100 patients aged 18-60 years of either sex undergoing elective surgery under general anaesthesia with endotracheal intubation.Preoperatively physical airway evaluation was performed byusing six parameters including Modified Mallampati class(MMC), thyromental distance(TMD), sternomental distance(SMD) , inter-incisor (IID)distance , hyomental distance(HMD)and neck circumference(NC). In preoperatively, Airway Ultrasoundwas performed andnoted the ratio of the depth of the preÃ¢Â€Â‘epiglottic space (PES) to the distance from the epiglottis to the midÃ¢Â€Â‘point of the distance between the vocal cords (EÃ¢Â€Â‘VC). CL grade was also noted during laryngoscopy. Compared ultrasound parameters with CormackÃ¢Â€Â“Lehane grade. Specificity,Sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracywere calculated.Airway ultrasound measurements were compared with physical parametersin predicting Cormack Ã¢Â€Â“Lehane grade. Results: The incidence of difficult intubation was 7%. Sensitivity of PES/E-VC ratio was higher than NC, TMD, HMD, IID and SMD but less than Mallampati class. Specificity, PPV was lower than physical parameters.NPV was comparable. Conclusion: Percutaneous airway ultrasound is useful and promising technique for predicting Cormack and Lehane grading but a combination of all these is definitely helpful for better prediction.

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Section: Discussion:-contrasting

confidence: 49%

Use of Ultrasound Parameters for Prediction of Difficult Intubation and Its Relation With the Cormack and Lehane Grade of Laryngoscopy

Dhaka¹,

Meena²,

Bansal³

et al. 2021

IJAR

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“…The results of both studies are comparable. In the study by Reddy et al .,[18] the value of mean Pre-E/E-VC were 1.09 ± 0.38, 1.28 ± 0.37 for CL Grade 1 and 2, whereas for CL Grade 3, it was 1.29 ± 0.44. However, in the study, the authors did not encounter patient with CL 4.…”

Section: Discussionmentioning

confidence: 95%

The usefulness of point of care ultrasound (POCUS) in preanaesthetic airway assessment

et al. 2019

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Background and Aims:Point of care ultrasound has the potential to become reliable airway assessment tool by accurate prediction of difficult laryngoscopy. We aimed to determine the feasibility of ultrasound in preoperative airway assessment.Methods:This prospective, observational study was conducted on 200 patients requiring general anaesthesia and tracheal intubation. The thickness of anterior soft tissue neck at the level of hyoid bone (DSHB), epiglottis (DSEM), and Pre-E/E-VC[depth of the pre-epiglottic space (Pre-E)/distance from the epiglottis to the midpoint of the distance between the vocal cords (E-VC)] were measured sonographically. The hyomental distance ratio (HMDR) was measured utilising distances with head in neutral and extended position. The primary outcome was the efficacy of the parameters in predicting difficult laryngoscopy[Cormack Lehane 3,4]. The secondary outcome was to correlate the parameters to CL grading.Results:Utilising receiver operating curves, cutoff value of HMDR for predicting difficult laryngoscopy was ≤1.0870 with sensitivity of 65%, specificity of 77%. The cutoff value, sensitivity andspecificity for Pre-E/E-VC were ≥1.785, 82.8% and 83.8%., respectively. The cutoff value of DSHB was ≥0.99 with sensitivity of 48% and specificity of 82%. The cutoff, sensitivity and specificity for DSEM were ≥1.615, 89.7%, and 64.8%, respectively. There was moderate positive correlations of DSHB, DSEM, and Pre-E/E-VC (r = 0.551 and 0.701, 0.787: P = 0.00), whereas moderate negative correlation observed with HMDR (r = -.0671: P = 0.00).Conclusion:The strong positive correlation of Pre-E/E-VC, DSEM, and moderate negative correlation of HMDR makes these ultrasound parameters reliable predictors for difficult laryngoscopy.

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“…Seventeen studies have been considered for secondary outcome. [28][29][30][31][32][33]38,41,44,46,[48][49][50][51]53,59,64 Patients with difficult direct laryngoscopy had higher DSE, DSVC, and DSHB values than patients with easy laryngoscopy, with MD of 0.38 cm (95% confidence interval [CI], 0.17-0.58 cm; P = .0004), 0.18 cm (95% CI, 0.01-0.35 cm; P = .04), and 0.23 cm (95% CI, 0.08-0.39 cm; P = .004), respectively (Figure 3; Supplemental Digital Content 1, Figures 4 and 5, http://links.lww.com/AA/D759). However, the level of heterogeneity was very high.…”

Section: Secondary Outcomementioning

confidence: 99%

Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis

Carsetti

Sorbello

Adrario

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Despite several clinical index tests that are currently applied for airway assessment, unpredicted difficult laryngoscopy may still represent a serious problem in anesthesia practice. The aim of this systematic review and meta-analysis was to evaluate whether preoperative airway ultrasound can predict difficult direct laryngoscopy in adult patients undergoing elective surgery under general anesthesia. METHODS: We searched the Medline, Scopus, and Web of Science databases from their inception to December 2020. The population of interest included adults who required tracheal intubation for elective surgery under general anesthesia without clear anatomical abnormalities suggesting difficult laryngoscopy. A bivariate model has been used to assess the accuracy of each ultrasound index test to predict difficult direct laryngoscopy. RESULTS: Fifteen studies have been considered for quantitative analysis of summary receiver operating characteristic (SROC). The sensitivity for distance from skin to epiglottis (DSE), distance from skin to hyoid bone (DSHB), and distance from skin to vocal cords (DSVC) was 0.82 (0.74–0.87), 0.71 (0.58–0.82), and 0.75 (0.62–0.84), respectively. The specificity for DSE, DSHB, and DSVC was 0.79 (0.70–0.87), 0.71 (0.57–0.82), and 0.72 (0.45–0.89), respectively. The area under the curve (AUC) for DSE, DSHB, DSVC, and ratio between the depth of the pre-epiglottic space and the distance from the epiglottis to the vocal cords (Pre-E/E-VC) was 0.87 (0.84–0.90), 0.77 (0.73–0.81), 0.78 (0.74–0.81), and 0.71 (0.67–0.75), respectively. Patients with difficult direct laryngoscopy have higher DSE, DSVC, and DSHB values than patients with easy laryngoscopy, with a mean difference of 0.38 cm (95% confidence interval [CI], 0.17–0.58 cm; P = .0004), 0.18 cm (95% CI, 0.01–0.35 cm; P = .04), and 0.23 cm (95% CI, 0.08–0.39 cm; P = .004), respectively. CONCLUSIONS: Our study demonstrates that airway ultrasound index tests are significantly different between patients with easy versus difficult direct laryngoscopy, and the DSE is the most studied index test in literature to predict difficult direct laryngoscopy. However, it is not currently possible to reach a definitive conclusion. Further studies are needed with better standardization of ultrasound assessment to limit all possible sources of heterogeneity.

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Utility of ultrasonography in preanaesthetic airway assessment

Cited by 6 publications

References 0 publications

Use of Ultrasound Parameters for Prediction of Difficult Intubation and Its Relation With the Cormack and Lehane Grade of Laryngoscopy

Use of Ultrasound Parameters for Prediction of Difficult Intubation and Its Relation With the Cormack and Lehane Grade of Laryngoscopy

The usefulness of point of care ultrasound (POCUS) in preanaesthetic airway assessment

Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis

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