Ultrasound as a new tool in the assessment of airway difficulties

Alessandri, Francesco; Antenucci, Giuseppe; Piervincenzi, Edoardo; Buonopane, Costantino Eugenio; Bellucci, Riccardo; Andreoli, Chiara; Fegatelli, Danilo Alunni; Ranieri, Marco; Bilotta, Federico

doi:10.1097/eja.0000000000000989

Cited by 56 publications

(63 citation statements)

References 26 publications

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“…It was significantly different between the Macintosh laryngoscope and Assistant technique groups (20.7 ± 4.2 mm vs 16.1 ± 6.1 mm, P < 0.001). This result was consistent with some previous studies [21,22], in which the distance from skin to hyoid bone as measured by ultrasound had certain predictive function for difficult laryngoscopy.…”

Section: Discussionsupporting

confidence: 93%

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

et al. 2020

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Background We aimed to distinguish the preoperative radiological indicators to predict the application of assistant techniques during intubation for patients undergoing selective cervical surgery. Methods A total of 104 patients were enrolled in this study. According to whether intubation was successfully accomplished by simple Macintosh laryngoscopy, patients were divided into Macintosh laryngoscopy group (n = 78) and Assistant technique group (n = 26). We measured patients’ radiographical data via their preoperative X-ray and MRI images, and compared the differences between two groups. Binary logistic regression model was applied to distinguish the meaningful predictors. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. The highest Youden’s index corresponded to an optimal cut-off value. Results Ten variables exhibited significant statistical differences between two groups (P < 0.05). Based on logistic regression model, four further showed correlation with the application of assistant techniques, namely, perpendicular distance from hard palate to tip of upper incisor (X2), atlanto-occipital gap (X9), angle between a line passing through posterior-superior point of hard palate and the lowest point of the occipital bone and a line passing through the anterior-inferior point and the posterior-inferior point of the second cervical vertebral body (Angle E), and distance from skin to hyoid bone (MRI 7). Angle E owned the largest AUC (0.929), and its optimal cut-off value was 19.9° (sensitivity = 88.5%, specificity = 91.0%). the optimal cut-off value, sensitivity and specificity of other three variables were X2 (30.1 mm, 76.9, 76.9%), MRI7 (16.3 mm, 69.2, 87.2%), and X9 (7.3 mm, 73.1, 56.4%). Conclusions Four radiological variables possessed potential ability to predict the application of assistant intubation techniques. Anaesthesiologists are recommended to apply assistant techniques more positively once encountering the mentioned cut-off values.

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Section: Discussionsupporting

confidence: 93%

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

et al. 2020

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“…The DA prevalence of our study was 15.7%, which is comparable to literature 3,6,14–16 . To date, no proper clinical parameters were described in determining DA.…”

Section: Discussionsupporting

confidence: 85%

“…These differences were statistically significant. Allessandri et al 6 has also assessed the distance from skin to the hyoid bone and epiglottis midway with the ultrasound. The mean HSD and ESD were 0.86 cm and 0.78 cm in the easy airway group, while 1.08 cm and 0.91 cm in the DA group.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Indirect Laryngoscopy, Clinical and Ultrasonographic Assessment in Prediction of Difficult Airway

et al. 2020

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Objectives Pre‐operative airway evaluation is essential to decrease the proportion of possible mortality and morbidity due to difficult airway (DA). The study aimed to evaluate the accuracy of pre‐operative ultrasonographic airway assessment (UAA) and indirect laryngoscopy (IL) in predicting DA. Study Design Prospective obsevational study. Methods Preoperative clinical examination (body mass index [BMI], mallampati classification [MP], thyromental distance, sternomental distance, neck circumference), UAA (epiglottis‐skin distance [ESD], hyoid bone‐skin distance [HSD], the thickness of tongue root [ToTR], anterior commissure‐skin distance [ACSD]) and IL with the rigid 70‐degree laryngoscope were performed to predict DA (Cormack‐Lehane grade 3 and 4). The sensitivity, specificity, positive predictive value (PP), and negative predictive values of the parameters were assessed. Results Twenty‐two of 140 (15.7%) patients were diagnosed with DA. The cut‐off points of ESD, HSD, ToTR, ACSD, and BMI were 2.09 cm, 0.835 cm, 4.05 cm, 0.545 cm, and 27.10, respectively. AUC values were 0.874, 0.885, 0.871, 0.658, and 0.751 in the same order. AUC values for IL and MP were 0.773 and 0.925, respectively. MP and HSD had the best sensitivity (91%), IL grading had the best specificity (100%), and PP (100%) value among all measurements. The best‐balanced sensitivity (91%), specificity (97%), and PP (88%) values were obtained by combining the IL with MP and ESD or with MP and HSD. Conclusions Ultrasonographic measurements and IL were found significantly correlated to predict DA. Combined parameters, the IL with MP and ESD or with MP and HSD, are the best parameters in predicting the DA. Level of Evidence 4 Laryngoscope, 131:E555–E560, 2021

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“…21,22 Skin-hyoid distance is known to predict difficult mask ventilation and difficult laryngoscopy, while the epiglottis-to-vocal cord space has been shown to correlate with Cormack-Lehane intubation grade. 23,24 Specifically, the mean standard deviation of the minimum distance from the hyoid bone to skin surface was 0.88 (0.3) cm in the easy mask ventilation group versus 1.4 (0.19) cm in the difficult mask ventilation group. The mean of this distance increased according to the level of difficulty of mask ventilation and laryngoscopy.…”

Section: Airway Ultrasound (Aus)mentioning

confidence: 97%

Point-of-Care Ultrasound (POCUS) for the Cardiothoracic Anesthesiologist

Kalagara

Coker

Gerstein

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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Point-of-Care Ultrasound (POCUS) is a valuable bedside diagnostic tool for a variety of expeditious clinical assessments or as guidance for a multitude of acute care procedures. Varying aspects of nearly all organ systems can be evaluated using POCUS and, with the increasing availability of affordable ultrasound systems over the past decade, many now refer to POCUS as the 21 st-century stethoscope. With the current available and growing evidence for the clinical value of POCUS, its utility across the perioperative arena adds enormous benefit to clinical decisionmaking. Cardiothoracic anesthesiologists routinely have used portable ultrasound systems for nearly as long as the technology has been available, making POCUS applications a natural extension of existing cardiothoracic anesthesia practice. This narrative review presents a broad discussion of the utility of POCUS for the cardiothoracic anesthesiologist in varying perioperative contexts, including the preoperative clinic, the operating room (OR), intensive care unit (ICU), and others. Furthermore, POCUS-related education, competence, and certification are addressed.

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Ultrasound as a new tool in the assessment of airway difficulties

Cited by 56 publications

References 26 publications

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

The Role of Indirect Laryngoscopy, Clinical and Ultrasonographic Assessment in Prediction of Difficult Airway

Point-of-Care Ultrasound (POCUS) for the Cardiothoracic Anesthesiologist

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