Preoperative difficult airway prediction using suprahyoid and infrahyoid ultrasonography derived measurements in anesthesiology

Petrișor, Cristina; Dîrzu, Dan Sebastian; Trancă, Sebastian; Hagău, Natalia; Bodolea, Constantin

doi:10.11152/mu-1764

Cited by 21 publications

(21 citation statements)

References 28 publications

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“…The investigator can easily identify the bright hyperechoic structures: the mandible and the hyoid bone. HMD is measured between the anterior border of the chin and the anterior border of the hyoid [17]. In the study by Petrisor et al [18], HMDR seemed to have superior diagnostic accuracy with a cut-off value of 1.23 provides 100% (39.8-100.0) sensitivity and 90.5% (69.6-98.8) speci city for the prediction of di cult airway in the obese population.…”

Section: Discussionmentioning

confidence: 97%

Preoperative X-ray C2C6AR is Applicable for Prediction of Difficult Laryngoscopy in Patients With Cervical Spondylosis

Zhou

Han

et al. 2020

Preprint

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Background: Airway management is one of the most important techniques in clinical anesthesia practice, and inappropriate airway management is related with airway injury, brain hypoxia, and even death. The patients with cervical spondylosis are often confronted with difficult laryngoscopy and are more prone to appear unexpected difficult airway, so it is important to figure out the most valuable predictor of difficult laryngoscopy in these patients.Methods: We randomly enrolled 270 patients undergoing elective cervical spine surgery and analyzed the cervical mobility data in predicting difficult laryngoscopy. The preoperative X-ray radiological indicators were measured by an attending radiologist. Cormack–Lehane scales were assessed during intubation, and patients with a class III or IV view were assigned to the difficult laryngoscopy group.Results: Univariate analysis showed that the hyomental distance (HMD, the distance between the hyoid bone and the tip of the chin) and the hyomental distance ratio (HMDR, the ratio between HMD in the extension position and the one in the neutral position) might not be suitable indicators in patients with cervical spondylosis. Binary multivariate logistic regression (backward-Wald) analyses identified two independent risk factors from the cervical mobility indicators that correlated best as a predictor of difficult laryngoscopy: modified Mallampati test (MMT) and C2C6AR (the ratio of the angle between a line passing through the bottom of the second cervical vertebra and a line passing through the bottom of the sixth cervical vertebra in the extension position over the one in the neutral position). The odds ratio (OR) and 95% CI were 2.292(1.093-4.803) and 0.493 (0.306-0.793), respectively. C2C6AR exhibited the largest area under the curve (0.714; 95% CI 0.633–0.794).Conclusions: C2C6AR based on preoperative X-ray images may be the most accurate predictor of cervical mobility indicators for difficult laryngoscopy in patients with cervical spondylosis.Trial registration: The study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn; identifier: ChiCTR-ROC-16008598) on June 6, 2016.

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Section: Discussionmentioning

confidence: 97%

Preoperative X-ray C2C6AR is Applicable for Prediction of Difficult Laryngoscopy in Patients With Cervical Spondylosis

Zhou

Han

et al. 2020

Preprint

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“…All ultrasound measurements were performed by a single researcher after positioning patients supine with head and neck in neutral position. A low frequency probe was placed on patient's neck perpendicular to skin to measure hyomental distance [8] (Figure 1). The researcher adjusted the ventilation according to the appropriate parameters for each patient.…”

Section: Ultrasonographic Measurementmentioning

confidence: 99%

“…A previous study demonstrated that one of upper airway anatomy parameters of hyomental distance, the distance between hyoid bone and tip of the chin, may considered a predictor for LMA size choice [8]. As such, we designed a prospective, randomised controlled study to compare the e cacy of weight-based method to hyomental distance-based method for individualized estimation of LMA size selection in breast cancer surgery patients.…”

Section: Introductionmentioning

confidence: 99%

Hyomental distance measured by ultrasound for size selection of laryngeal mask airway in female patients: a randomized controlled study

Wang

Tang

2021

Preprint

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BackgroundOptimal size selection of classic laryngeal mask airway (LMA) remains a major challenge for anaesthesiologists. Because the body weight, current method to select LMA size, might not inconsistent with dimension of hypopharynx where LMA is positioned. Hyomental distance by ultrasound as an common parameter in upper airway may be considered a predictor of LMA size choice, that we conducted a randomized, controlled study to compare the efficacy of size selection between commonly recommended weight-based method and hyomental distance-based method.MethodsSeventy female patients undergoing breast cancer surgery were enrolled in our study and randomly assigned into either the hyomental distance group or weight group. The primary outcome was the correct rate of selection LMA without need for size adjustment or use of other devices. Secondary outcomes included injury rate, oropharyngeal leak pressure (OLP), and insertion attempts.ResultsTwo participants were excluded from weight group due to tracheal intubation. The correct rate of LMA size-selected were significant difference of 77.14% and 51.51% in hyomental distance group and weight group, respectively(P=0.027). Five (14.29%) and 7 (21.21%) patients were injured in hyomental-distance group and weight group, respectively. Values of OLP in two groups were 22 (19-24) cmH2O and 22 (19.5-24) cmH2O, respectively. The insertion attempts were the same in both groups and no statistical differences were observed regarding these three outcomes. ConclusionThe hyomental distance-based method possessed a higher success rate for LMA-classic size selection than did the weight-based method, with the same excellent OLP value, low possibility of injury, and a low number of insertion attempts as weight-based method. Trial registrationOur study was registered with the Chinese Clinical Trial Registry (ChiCTR1900021123), registered 29 January 2019.

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“…When measured, the patient should be asked to lie supine and put the head in a neutral position. Generally, a 6-13 MHz high-frequency ultrasonic transducer is used for ultrasonic scanning (22,23). The linear ultrasonic probe is placed vertically on the larynx to measure the vertical distance between the skin and six different anatomical sites.…”

Section: Thickness Of Anterior Neck Soft Tissuementioning

confidence: 99%

Advances in studies on imaging and artificial intelligence technology-assisted difficult airway assessment

Wang¹,

Xia²,

Jiang³

2021

Front Oral Maxillofac Med

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Endotracheal intubation is an indispensable part to ensure oxygen supply for patients who undergo general anesthesia in surgeries. However, despite great progress and improvement in intubation technology and equipment, the incidence of perioperative complications and disabilities caused by difficult airway has not been well improved, especially for unpredictable difficult airway. At present, the accuracy of the difficult airway assessment methods are not high and the process is complex, so it is our focus to optimize the difficult airway prediction process and improve the prediction accuracy. At present, imaging and artificial intelligence (AI) face recognition technology as an aid to the assessment of difficult airways is significantly better than the traditional assessment methods. However, imaging techniques such as X-ray, CT, MRI, and ultrasound have their own clinical application value, while at the same time have many limitations, such as radiation, medical costs, equipment requirements, and medical staff burden, which prevent them from being widely used in clinical practice. On the other hand, AI technology in difficult airway identification is still in the sprouting stage, with the technology being immature and lacks sufficient research evidence to support it. For this reason, we have reviewed the literature on imaging technology and AI technology-assisted assessment of difficult airway in recent years, and we hope to provide new ideas for further research and to shed light on the emergence of a convenient and accurate method for difficult airway early warning, thus optimizing the clinical workflow, reducing the risk of misclassification, and ensuring the perioperative life safety of patients.

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Preoperative difficult airway prediction using suprahyoid and infrahyoid ultrasonography derived measurements in anesthesiology

Cited by 21 publications

References 28 publications

Preoperative X-ray C2C6AR is Applicable for Prediction of Difficult Laryngoscopy in Patients With Cervical Spondylosis

Preoperative X-ray C2C6AR is Applicable for Prediction of Difficult Laryngoscopy in Patients With Cervical Spondylosis

Hyomental distance measured by ultrasound for size selection of laryngeal mask airway in female patients: a randomized controlled study

Advances in studies on imaging and artificial intelligence technology-assisted difficult airway assessment

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