Feasibility of ultrasound measurement of tracheal diameter in patients undergoing severe scoliosis orthopedic surgery: A randomized trial

Abstract

Objective To explore the feasibility of ultrasound measurement of the transverse diameter of the cervical trachea at its narrowest point in patients undergoing severe scoliosis orthopedic surgery. Methods A total of 110 patients, aged 18-65, who scheduled for elective orthopedic surgery for severe scoliosis were included. Prior to surgery, all patients underwent two types of tracheal inner diameter measurements: (1) CT measurement of the anteroposterior diameter (Dmin,AP) and transverse diameter (Dmin,T) of the cervical trachea at its narrowest point; and (2) ultrasound measurement of Dmin,T. Based on the measurement results, the patients were randomly divided into two groups, the CT group ( n = 55) and the ultrasound group ( n = 55). We compared the Dmin,AP and Dmin,T measured by CT for all patients. Then, we compared CT and ultrasound measurements of Dmin,T. Furthermore, we conducted an analysis to determine the correlation and consistency between the two methods. Additionally, we examined the success rate of first-attempt tracheal intubation and the occurrence rate of tracheal tube being too wide or too narrow between the two groups, and assessed the occurrence of postoperative 24-h pharyngeal pain and hoarseness. Results When comparing the Dmin,AP and Dmin,T measured by CT in all patients, a statistically significant difference was observed ( p < .001). When comparing the measurements of Dmin,T between CT and ultrasound in all patients, no statistically significant differences were found ( p > .05). The correlation coefficient (r) between CT and ultrasound measurements of Dmin,T was 0.849 ( p < .001). The mean difference in Dmin,T was 0.19 mm, and the limits of agreement (LoA) were −2.24 mm to 2.62 mm. Conclusions Ultrasound measurement of Dmin,T in severe scoliosis patients is feasible and provides valuable guidance for the selection of endotracheal tube sizes. It serves as a non-invasive and bedside auxiliary examination method for perioperative airway assessment.