The Evaluation of Upper Airway: Point of Care Ultrasound vs. Conventional Tests
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Abstract
Objective: The ultrasound-guided interventions have gained widespread popularity in several aspects of anesthesia practice. In this study, we aimed to compare the preoperative evaluation tests and sonographic measurements of the upper airway for the prediction of a potentially difficult airway.
Material and Methods: In this prospective observational study, we enrolled 136 adult patients undergoing elective surgery under general anesthesia. The Modified Mallampati classification, thyromental distance, sternomental distance, and Cormack-Lehane scores were recorded. Sonographic measurements included pre-epiglottic space (PES), the distance between the midpoints of vocal cords and epiglottis (EVC). The ratio was interpreted. Main outcome is to determine the sensitivity and specificity of the upper airway ultrasound for the prediction of a potentially difficult airway.
Results: There was no statistically significant relationship between body mass index value and thyromental distance, Thyromental/Sternomental Ratio and PES/EVC ratio, Cormack-Lehane, Mallampati classification and thyromental/sternomental distance ratio (p>0.05). The sonographic measurements of airway have no significance to predict the difficult intubation and the comparison between PES, EVC and the PES/EVC ratio and assessment tests (Cormack-Lehane, Mallampati classification, thyromental and sternomental distances) was insignificant. The sternomental distance measurement was predictive for the difficult airway only in patients having body mass index more than 31.6 kg m-2.
Conclusion: Ultrasound is a useful tool for identifying the upper airway prior to anesthesia but the validity for the prediction of difficult airway is not clear. By increasing the clinical experiences and further investigations, a greater insight into its use will be gained.
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Accepted 2019-12-15
Published 2019-12-26
References
Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits AM, Arrich J, et al. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst Rev 2018; 5(5): CD008874. Published 2018 May 15. doi:10.1002/14651858.CD008874.pub2
Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al; American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; Feb; 118(2): 251-70.
Adnet F, Borron SW, Racine SX, Clemessy JL, Fournier JL, Plaisance P, et al .The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology 1997; Dec; 87(6): 1290-7.
Prasad A, Yu E, Wong DT, Karkhanis R, Gullane P, Chan VW. Comparison of sonography and computed tomography as imaging tools for assessment of airway structures. J Ultrasound Med 2011; Jul; 30(7): 965-72.
Kristensen MS. Ultrasonography in the management of airway. Acta Anaesthesiol Scand 2011; Nov; 55(10): 1155-73.
Wu J, Dong J, Ding Y, Zheng J. Role of anterior neck soft tissue quantifications by ultrasound in predicting difficult laryngoscopy. Med Sci Monit 2014; Nov 18; 20: 2343-50.
Adhikari S, Zeger W, Schmier C, Crum T, Craven A, Frrokaj I, et al. Pilot study to determine the utility of point-of-care ultrasound in the assessment of difficult laryngoscopy. Acad Emerg Med 2011; Jul; 18(7):754-8.
Sankal A, Halemani KR, Bhadrinath N. Assessment of the effect of supine posture and phonation on modified mallampati grading and its applicability in prediction of difficult airway. J Mahatma Gandhi Inst Med Sci 2018; 23: 19-24.
Khan ZH, Eskandari S, Yekaninejad MS. A comparison of the Mallampati test in supine and upright positions with and without phonation in predicting difficult laryngoscopy and intubation: A prospective study. J Anaesthesiol Clin Pharmacol 2015; Apr-Jun; 31(2):207-11.
Liaskou C, Vouzounerakis E, Moirasgenti M, Trikoupi A, Staikou C. Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study. Indian J Anaesth 2014 Mar; 58(2): 176-82.
Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 9(11): 1105-11.
Rana S, Verma V, Bhandari S, Sharma S, Koundal V, Chaudhary SK. Point-of-care ultrasound in the airway assessment: A correlation of ultrasonography-guided parameters to the Cormack-Lehane Classification. Saudi J Anaesth 2018; 12: 292-296.
Hall EA, Showaihi I, Shofer FS, Panebianco NL, Dean AJ. Ultrasound evaluation of the airway in the ED: a feasibility study. Crit Ultrasound J 2018; Jan 18; 10(1):3. doi: 10.1186/s13089-018-0083-6.
Reddy PB, Punetha P, Chalam KS. Ultrasonography- A viable tool for airway assessment. Ind J Anaesth 2016; 60:807-13.
Aktas S, Atalay YO, Tugrul M. Predictive value of bedside tests for difficult intubation. Eur Rev Med Pharmacol Sci 2015; 19 (9): 1595-9.
Seo SH, Lee JG, Yu SB, Kim DS, Ryu SJ, Kim KH. Predictors of difficult intubation defined by the intubation difficulty scale (IDS): predictive value of 7 airway assessment factors. Korean J Anesthesiol 2012; Dec; 63(6):491-7.
Baker PA, Depuydt A, Thompson JM. Thyromental distance measurement-fingers don’t rule. Anaesthesia 2009 Aug; 64(8):878-82.
Baker P. Assessment before airway management. Anesthesiol Clin 2015; Jun;33(2):257-78.
Selvi O, Kahraman T, Senturk O, Tulgar S, Serifsoy E, Ozer Z. Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study. J Clin Anesth 2017; Feb; 36:21-26.
Javaher Foroosh Zadeh F, Safaii S. Comparison of four methods for predicting difficult intubation. Int J Bioassays 5.1 2016; 4720-22.
Lundstrøm LH, Vester-Andersen M, Møller AM, Charuluxananan S, L'hermite J, Wetterslev J; Danish Anaesthesia Database. Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients. Br J Anaesth. 2011 Nov; 107(5):659-67.
Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits AM, Arrich J et al. Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review. Anaesthesia 2019; Jul; 74(7):915-928.
Acer M, Akkaya A, Tuğay BU, Öztürk A. A Comparison of Cormeck-Lehane and Mallampati tests with mandibular and neck measurements for predicting difficult intubation. Balkan Med J 2011; 28: 157-163.
Prakash S, Mullick P, Bhandari S, Kumar A, Gogia AR, Singh R. Sternomental distance and sternomental displacement as predictors of difficult laryngoscopy and intubation in adult patients. Saudi J Anaesth 2017; Jul-Sep;11(3):273-278.
Gupta D, Stirajakalidindi A, Ittiara B, Apple L, Toshniwal G, Haber H. Ultrasonographic modification of Cormack-Lehane classification for pre-anesthetic assessment. Middle East J Anaesthesiol 2012; Oct; 21(6):835-42.
Mohammadi SS, Saliminia A, Nejatifard N, Azma R. Usefulness of ultrasound view of larynx in pre-anesthetic airway assessment: A comparison with Cormack-Lehane classification during direct laryngoscopy. Anesth Pain Med 2016; 6(6): e39566.