Ultrasound-based airway assessment in obese patients as a valuable tool for predicting difficult airway: an observational study
Avaliação das vias aéreas por ultrassom em pacientes obesos como uma ferramenta valiosa para prever vias aéreas difíceis: um estudo observacional
Ozan Tasdemir, Nazan Kocaoglu, H. Fisun Demir, Fatih Ugun, Ozlem Sagir
Abstract
Background
Difficult airway, characterized by difficult mask ventilation and intubation, is common in obese patients undergoing surgery. The purpose of this study was to evaluate and compare the prognostic efficiency of ultrasound-measured anterior cervical soft tissue parameters as an indicator of difficult airway during anesthesia induction in obese patients.
Methods
This prospective, double-blind, observational study was conducted at Balikesir University Faculty of Medicine Hospital between March 2020 and March 2022. A total of 157 patients age ≥ 18 (BMI ≥ 30 kg.m-2), without previous head and neck surgery were included in the study. Anterior cervical soft tissue measurements were performed at three levels; minimum distance between the hyoid bone and skin at the level of the hyoid bone; (DSHB), distance between the midpoint of the epiglottis and skin at the level of the thyrohyoid membrane; (DSE), distance between the anterior commissure of vocal cords and skin at the vocal cord level; (DSV). The Han scale was used to assess difficult mask ventilation and the Cormack-Lehane scale was used to assess difficult laryngoscopy.
Results
In the difficult laryngoscopy group, the mean values of DSHB, DSE and DSV were 18.5 ± 3.5, 18.3 ± 3.8, and 18.6 ± 3.4, respectively. The AUC values for DSHB, DSE, and DSV were 0.845, 0.827, and 0.850, respectively. Anterior cervical measurements showed a better predictive value for difficult laryngoscopy compared to difficult mask ventilation.
Conclusion
Ultrasonographic measurements were predictive for difficult laryngoscopy and ventilation with better correlation in laryngoscopy.
Keywords
Resumo
Introdução
A via aérea difícil, caracterizada por ventilação e intubação difíceis por máscara, é comum em pacientes obesos submetidos à cirurgia. O objetivo deste estudo foi avaliar e comparar a eficiência prognóstica dos parâmetros do tecido mole cervical anterior medidos por ultrassom como um indicador de via aérea difícil durante a indução da anestesia em pacientes obesos.
Métodos
Este estudo prospectivo, duplo-cego e observacional foi conduzido no Hospital da Faculdade de Medicina da Universidade de Balikesir entre março de 2020 e março de 2022. Um total de 157 pacientes com idade ≥ 18 (IMC ≥ 30 kg.m-2), sem cirurgia prévia de cabeça e pescoço foram incluídos no estudo. As medições do tecido mole cervical anterior foram realizadas em três níveis; distância mínima entre o osso hioide e a pele no nível do osso hioide; (DSHB), distância entre o ponto médio da epiglote e a pele no nível da membrana tireo-hióidea; (DSE), distância entre a comissura anterior das cordas vocais e a pele no nível das cordas vocais; (DSV). A escala de Han foi usada para avaliar a ventilação difícil com máscara e a escala de Cormack-Lehane foi usada para avaliar a laringoscopia difícil.
Resultados
No grupo de laringoscopia difícil, os valores médios de DSHB, DSE e DSV foram 18,5 ± 3,5, 18,3 ± 3,8 e 18,6 ± 3,4, respectivamente. Os valores de AUC para DSHB, DSE e DSV foram 0,845, 0,827 e 0,850, respectivamente. As medidas cervicais anteriores mostraram um melhor valor preditivo para laringoscopia difícil em comparação com a ventilação difícil com máscara.
Conclusão
As medidas ultrassonográficas foram preditivas para laringoscopia difícil e ventilação com melhor correlação na laringoscopia.
Palavras-chave
References
1. Richa F, El-Hage C, Chalhoub V, Yazbeck P. Prediction of difficult laryngoscopy and/or intubation among morbidly obese patients: Upper lip bite test versus modified Mallampati classification. J Perioper Pract. 2023. https://doi.org/10.1177/ 17504589231206903. Online ahead of print.
2. Moura ECR, Filho ASM, de Oliveira EJSG, et al. Comparative Study of Clinical and Ultrasound Parameters for Defining a Difficult Airway in Patients with Obesity. Obes Surg. 2021;31:4118 −24.
3. Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005; 103:429−37.
4. Roth D, Pace NL, Lee A, et al. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst Rev. 2018;5:CD008874.
5. Petrisor C, D^ırzu D, Tranca S, Hag au N, Bodolea C. Preoperative difficult airway prediction using suprahyoid and infrahyoid ultrasonography derived measurements in anesthesiology. Med Ultrason. 2019;21:83.
6. Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136:31−81.
7. Pinto J, Cordeiro L, Pereira C, Gama R, Fernandes HL, Assunc¸ ao J. ~ Predicting difficult laryngoscopy using ultrasound measurement of distance from skin to epiglottis. J Crit Care. 2016;33:26−31.
8. Komatsu R, Sengupta P, Wadhwa A, et al. Ultrasound Quantification of Anterior Soft Tissue Thickness Fails to Predict Difficult Laryngoscopy in Obese Patients. Anaesth Intensive Care. 2007; 35:32−7.
9. Yadav N, Rudingwa P, Mishra S, Pannerselvam S. Ultrasound measurement of anterior neck soft tissue and tongue thickness to predict difficult laryngoscopy ‒ An observational analytical study. Indian J Anaesth. 2019;63:629.
10. Adhikari S, Zeger W, Schmier C, et al. Pilot study to determine the utility of point-of-care ultrasound in the assessment of difficult laryngoscopy. Acad Emerg Med. 2011;18:754−8.
11. Sharma DK. Ultrasound Guided Preoperative Airway Assessment and Its Correlation with Standard Clinical Airway Assessment in Patients Having BMI >23 KG/M2. J Med Sci Clin Res. 2020;8(6).
12. Fulkerson JS, Moore HM, Anderson TS, Lowe RF. Ultrasonography in the preoperative difficult airway assessment. J Clin Monit Comput. 2017;31:513−30.
13. Wang X, Wang Y, Zheng ZW, Liu YR, Ma WH. Ultrasound measurements for evaluation of changes in upper airway during anaesthesia induction and prediction difficult laryngoscopy: a prospective observational study. Sci Rep. 2022;12:18564.
14. Dixit A, Kulshrestha M, Mathews JJ, Bhandari M. Are the obese difficult to intubate? Br J Anaesth. 2014;112:770−1.
15. 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;20:2343−50.
16. Fernandez-Vaquero MA, Charco-Mora P, Garcia-Aroca MA, Greif R. Preoperative airway ultrasound assessment in the sniffing position: a prospective observational study. Braz J Anesthesiol. 2023;73:539−47.
17. Ezri T, Gewurtz G, Sessler DI, et al. Prediction of dif € ficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia. 2003;58:1111−4.
18. Prathep S, Jitpakdee W, Woraathasin W, Oofuvong M. Predicting difficult laryngoscopy in morbidly obese Thai patients by ultrasound measurement of distance from skin to epiglottis: a prospective observational study. BMC Anesthesiol. 2022;22:145.
19. Balakrishnan K, Chockalingam P. Ethnicity and upper airway measurements: A study in South Indian population. Indian J Anaesth. 2017;61:622.
20. Hung KC, Chuang MH, Kang FC, et al. Prevalence and risk factors of difficult mask ventilation: A systematic review and metaanalysis. J Clin Anesth. 2023;90:111197.
21. Leoni A, Arlati S, Ghisi D, et al. Difficult mask ventilation in obese patients: analysis of predictive factors. Minerva Anestesiol. 2014;80:149−57.
22. Cattano D, Katsiampoura A, Corso RM, Killoran PV, Cai C, Hagberg CA. Predictive factors for difficult mask ventilation in the obese surgical population. F1000Res. 2014;3:239.
23. Giordano G, Alessandri F, Zulian A, Bilotta F, Pugliese F. Preoperative ultrasound prediction of difficult airway management in adult patients: A systematic review of clinical evidence. Eur J Anaesthesiol. 2023;40:313−25.
24. Alessandri F, Antenucci G, Piervincenzi E, et al. Ultrasound as a new tool in the assessment of airway difficulties: An observational study. Eur J Anaesthesiol. 2019;36:509−15.
25. Bianchini A, Nardozi L, Nardi E, Scuppa MF. Airways ultrasound in predicting difficult face mask ventilation. Minerva Anestesiol. 2021;87:26−34.
26. Stutz EW, Rondeau B. Mallampati Score. 2024.
27. Lundstrøm LH, Vester-Andersen M, Møller AM, et al. Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients. Br J Anaesth. 2011;107:659−67.
28. Wang T, Sun S, Huang S. The association of body mass index with difficult tracheal intubation management by direct laryngoscopy: a meta-analysis. BMC Anesthesiol. 2018;18:79.
29. Wang LY, Zhang K da, Zhang ZH, Zhang DX, Wang HL, Qi F. Evaluation of the reliability of the upper lip bite test and the modified mallampati test in predicting difficult intubation under direct laryngoscopy in apparently normal patients: a prospective observational clinical study. BMC Anesthesiol. 2022;22:314.
30. Khan ZH, Kashfi A, Ebrahimkhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg. 2003;96:595−9. table of contents.
Submitted date:
02/01/2024
Accepted date:
06/29/2024
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