Preoperative airway ultrasound assessment in the sniffing position: a prospective observational study
Avaliação ultrassonográfica pré-operatória das vias aéreas na posição olfativa: um estudo observacional prospectivo
Miguel Angel Fernandez-Vaquero, Pedro Charco-Mora, Miguel Angel Garcia-Aroca, Robert Greif
Abstract
Keywords
Resumo
Introdução
Os testes de triagem clínica das vias aéreas pretendem prever vias aéreas difíceis, mas nenhum tem alto valor preditivo. Revisões sistemáticas recentes correlacionam ultrassonografia com laringoscopia difícil. Este estudo teve como objetivo principal correlacionar as medidas ultrassonográficas das estruturas anatômicas das vias aéreas superiores na posição olfativa com a laringoscopia direta difícil. O objetivo secundário era observar as diferenças baseadas no gênero.
Métodos
Este estudo observacional prospectivo, transversal e de centro único incluiu 209 pacientes que necessitavam de anestesia geral para cirurgia eletiva. No pré-operatório, foram realizadas seis avaliações clínicas das vias aéreas e três medidas ultrassonográficas, que foram a Distância da Pele ao Osso Hioide (DSHB), à Epiglote (DSE) e à comissura anterior das cordas vocais (DSAC) em posição olfativa. Os critérios de Benumof para “melhor visualização na primeira tentativa” para laringoscopia direta avaliaram a dificuldade da laringoscopia.
Resultados
A distância da pele à epiglote foi o melhor preditor de laringoscopia direta difícil (definida como grau Cormack-Lehane ≥ 2b) com um corte mínimo de espessura de 2,70 ± 0,19 cm (sensibilidade 91,3%; especificidade 96,9%). O ponto de corte da distância da pele ao osso hioide foi de 1,41 ± 0,30 cm com correlação moderada (sensibilidade 80,4%; especificidade 60,1%). Nenhuma correlação foi encontrada para a distância à comissura anterior das pregas vocais. Nas mulheres em relação aos homens, a distância da pele à epiglote foi mais sensível (92,3% vs. 90,9%) e específica (98,8% vs. 95,2%).
Conclusão
O DSE na posição olfativa é o parâmetro mais confiável para avaliação ultrassonográfica pré-operatória das vias aéreas na população caucasiana, com maior sensibilidade e especificidade em mulheres, e pode ser considerado um preditor independente para laringoscopia direta difícil.
Palavras-chave
References
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Submitted date:
01/12/2022
Accepted date:
07/19/2022
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