Ultrasound as an Assessment Method in Predicting Difficult Intubation: A Prospective Clinical Study
- 92 Downloads
Aim of the study is to predict the difficulty in intubation preoperatively using ultrasonography.
One hundred and thirty-seven patients underwent ultrasound followed by surgery under general anesthesia. A experienced radiologist examined the airway and performed measurements of specific airway parameters: visualization of hyoid bone, visualization of vocal cords through thyroid cartilage, visualization of epiglottis, distance from base of tongue to hyoid bone, distance of hyomental region distance of thyrohyoid region, distance between skin and fat pad thickness to thyroid cartilage, thickness of submental region, distance from epiglottis to skin (above hyoid), and visualization of cricothyroid membrane. After performing ultrasound, patient was presented for surgery. An experienced anesthesiologist who is associated with this study did all the laryngoscopy and intubation.
We were able to visualize all relevant anatomical structures in all the participants using ultrasound. The receiver operating characteristic curve analysis results showed that hyomental is ≤ 1.09 (P value < 0.01) to classify difficult in intubation.
The study shows that ultrasound can reliably image all the airway structures. This study suggests that hyomental distance is a more valid criterion in predicting difficult intubation. Further, case control study is needed for assessing the ease of intubation.
KeywordsAirway Intubation Ultrasonography Laryngoscopy
I am extremely thankful to Dr. Santhosh Pasupuleti, Radiologist, for helping, guiding and teaching me about ultrasound. I would like to thank my colleagues in the department for all their support, help, and constructive criticism and in making this an invaluable and enjoyable experience.
Compliance with Ethical Standards
Ethical clearance certificate obtained from institutional review board. All procedures performed in studies involving human participants were in accordance with ethical standards of institutional research committee and with 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent obtained from the involved human participants.
- 6.Vasudevan A, AB Adhe (2008) Predictors of difficult intubation—a simple approach. Internet J Anesthesiol 20(2):2Google Scholar
- 7.Management of Unanticipated Difficult Intubation (2010) [Blog] Pennsylvania Patient Safety Advisory. Available at: http://patientsafety.pa.gov/ADVISORIES/documents/201012_home.pdf
- 9.Gupta AK, Mohamad O, Showkat N, Imtiyaz N, Anjali M (2010) Predictors of difficult intubation: study in Kashmiri population. Br J Med Practitioners 3(1):307Google Scholar
- 18.Law JA, Broemling N, Cooper RM, Drolet P, Duggan LV, Griesdale DE, Hung OR, Jones PM, Kovacs G, Massey S, Morris IR, Mullen T, Murphy MF, Preston R, Naik VN, Scott J, Stacey S, Turkstra TP, Wong DT (2013) The difficult airway with recommendations for management—part 2—the anticipated difficult airway. Can J Anaesth 60:1119–1138CrossRefGoogle Scholar
- 19.Laura F, Cavallone MD, Vannucci A (2013) Extubation of the difficult airway and extubation failure. Int Anaesth Res Soc 116(2):368–383Google Scholar
- 20.Balakrishnan M, Kuriakose R, Koshy RC (2004) Radiation induced changes in the airway—anaesthetic implications. South Afr J Anaesth Analg 10:19–21Google Scholar