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
Referências
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Submetido em:
01/02/2024
Aceito em:
29/06/2024
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