Is Ultrasonic Investigation Reasonable for Evaluation of Difficult Airway in Pregnant Women

Abstract

Objective: The aim of this study was to compare clinical screening tests (modified Mallampati score, Cormack-Lehane score, thyromental distance, and sternomental distance) with ultrasonic measurements of the upper airway in predicting difficult intubation in pregnant women whose Body Mass Index (BMI) is higher and lower than 30 kg m-2. Methods: This study was designed as a prospective observational trial, and consisted of 40 pregnant women of American Society of Anesthesiologists (ASA) 1-2 groups. Patients with a BMI lower than 30 kg m-2 were included in Group 1 (n=20), and patients with a BMI higher than 30 kg m-2 were included in Group 2 (n=20). In the supine position with head in mild extension, the diameter of the transverse tracheal air shadow in the subglottic area of the front neck was measured using ultrasonography. Modified Mallampati score, Cormack-Lehane score, thyromental distance and sternomental distance measurements were recorded. Results: No statistically significant difference was detected between groups regarding mean age, mean number of pregnancy, ASA scores and comorbid disease. Mean body weight (p=0.0001) and mean pre-pregnancy weight (p=0.0001) were significantly higher in Group 2. There was no statistically significant difference between groups regarding mean modified Mallampati score, thyromental distance, sternomental distance measurements, Cormack-Lehane score, and mean ultrasonic measurements. Conclusion: It was found that BMI higher or lower than 30 kg m-2 has no effect on ultrasonic measurements and clinical airway tests. We thought that ultrasonic measurement could not give us valuable information in obese or non-obese pregnant women.

Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis

“…Two studies were excluded because of a different definition of difficult direct laryngoscopy, 60 , 61 and 2 studies enrolling pregnant women were excluded. 62 , 63 …”

The association of body mass index with difficult tracheal intubation management by direct laryngoscopy: a meta-analysis

“…Twelve studies with a total of 5678 patients were analysed the association between obesity and risk of Mallampati score ≥ 3 [ 7 , 14 , 23 , 24 , 26 , 28 – 34 ]. There were five case-control studies (two in the USA [ 23 , 28 ], one [ 27 ] in Germany, one in Denmark [ 35 ], and one in Ireland [ 32 ]) and 11 cohort studies (two in France [ 7 , 24 ], two in Turkey [ 25 , 31 ], one in Brazil [ 30 ], one in Israel [ 14 ], two in the USA [ 26 ], one in Greece [ 29 ] one in Italy [ 34 ] and one in the UK [ 33 ]). Two studies included parturients [ 25 , 31 ], and 14 recruited non-parturients [ 7 , 14 , 23 , 24 , 26 – 30 , 32 – 34 ].…”

“…There were five case-control studies (two in the USA [ 23 , 28 ], one [ 27 ] in Germany, one in Denmark [ 35 ], and one in Ireland [ 32 ]) and 11 cohort studies (two in France [ 7 , 24 ], two in Turkey [ 25 , 31 ], one in Brazil [ 30 ], one in Israel [ 14 ], two in the USA [ 26 ], one in Greece [ 29 ] one in Italy [ 34 ] and one in the UK [ 33 ]). Two studies included parturients [ 25 , 31 ], and 14 recruited non-parturients [ 7 , 14 , 23 , 24 , 26 – 30 , 32 – 34 ]. Of the included studies, emergent tracheal intubation was used in two [ 23 , 25 ] and non-emergent tracheal intubation in the other 14 [ 7 , 14 , 24 , 26 – 34 ].…”

Change in Mallampati Score during Pregnancy, Labour and Post Labour: An Observational Study

“…The MP score is derived from a simple airwayclassification system and is used to recognize the risk of difficult tracheal intubation. 7 The MP classification includes four grades (1, 2, 3 and 4) depending on the soft palate visibility, 8 with grade 4 being the worst.…”