Airway ultrasound for patients anticipated to have a difficult airway: Perspective for personalized medicine

Abstract

Airway ultrasound allows for precise airway evaluation, particularly for assessing the difficult airway and the potential for front of neck access. Many studies have shown that identification of the cricothyroid membrane by airway ultrasound is more accurate than digital palpation. However, no reports to date have provided clinical evidence that ultrasound identification of the cricothyroid membrane increases the success rate of cricothyroidotomy. This is a narrative review which describes patients with difficult airways for whom airway ultrasound may have been useful for clinical decision making. The role of airway ultrasound for the evaluation of difficult airways is summarized and an approach to the use of ultrasound for airway management is proposed. The goal of this review is to present practical applications of airway ultrasound for patients predicted to have a difficult airway and who undergo cricothyroidotomy.

Point-of-care ultrasound for airway management in the emergency and critical care setting

“…The first is the distance from the skin to the epiglottis (DSE) [17][18][19][20][21][22]. This measurement is taken at the level of the thyrohyoid membrane.…”

Management of an Anticipated Difficult Airway in a Pediatric Patient With Stickler Syndrome

“…SS has a broad spectrum of craniofacial manifestations, that also include malar hypoplasia, a small jaw, high arched palate, a broad nasal bridge or micro/retrognathia, and a propensity for upper airway obstruction [2]. The prevalence of cleft palate in SS patients is estimated at approximately 40%, and 24% of patients are born with Pierre-Robin Sequence (small lower jaw, cleft palate, and tongue-bases obstruction) [2,3], a condition known to predispose patients to perioperative airway and respiratory complications [4]. Anesthetic management reports of SS patients are scarce but described complications include difficult facemask ventilation, oxygenation, and/or intubation, which may therefore represent an anticipated difficult airway (ADA) scenario.…”