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Ultrasonography for predicting a difficult laryngoscopy. Getting closer.

Alejandro Martínez-García1,2, José L Guerrero-Orriach3, María A Pino-Gálvez4

  • 1Department of Anesthesia and Critical Care, University Hospital of Jaén, Jaén, Spain. alexmartinez2406@gmail.com.

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|January 30, 2020
PubMed
Summary
This summary is machine-generated.

Ultrasound measurements of neck soft tissue can predict difficult laryngoscopy (DL). Measurements like epiglottis to skin (DSE) and DSE minus glottis to skin (DSG) showed high accuracy in predicting DL.

Keywords:
Airway managementAnesthesiaCritical careEndotracheal intubationLaryngoscopyUltrasonography

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Area of Science:

  • Anesthesiology
  • Medical Imaging

Background:

  • Difficult laryngoscopy (DL) poses a significant risk during airway management.
  • Predictive tools for DL are crucial for patient safety.
  • Ultrasound is a non-invasive imaging technique with potential for preoperative airway assessment.

Purpose of the Study:

  • To evaluate the effectiveness of five ultrasound measurements in predicting difficult laryngoscopy (DL).
  • To determine the diagnostic accuracy and optimal cut-off points for ultrasound measurements in identifying patients with DL.
  • To assess the combined utility of ultrasound measurements and classic clinical tests for DL prediction.

Main Methods:

  • Prospective observational study involving 50 patients undergoing general anesthesia.
  • Ultrasound measurements of neck soft tissue: skin to hyoid (DSH), epiglottis (DSE), glottis (DSG), and derived measures (DSH+DSE, DSE-DSG).
  • Statistical analysis included t-tests, ROC curves, logistic regression, and multivariate analysis, comparing ultrasound findings with laryngoscopy outcomes.

Main Results:

  • Patients with DL exhibited significantly greater DSE, DSH+DSE, and DSE-DSG measurements compared to those with easy laryngoscopy (p<0.001 for all).
  • DSE and DSE-DSG demonstrated high diagnostic accuracy for DL, with areas under the ROC curve of 0.79 and 0.82, respectively.
  • Specific cut-off points (DSE ≥ 3 cm and DSE-DSG ≥ 1.9 cm) predicted DL with positive predictive values of 69.23% and 78.57%, respectively.

Conclusions:

  • Ultrasound measurements, particularly DSE and DSE-DSG, are valuable tools for predicting difficult laryngoscopy.
  • Combining ultrasound parameters with classic clinical tests (Mallampati score, thyromental distance, upper lip bite test) enhances the preoperative detection of DL.
  • Integrating these ultrasound measurements into clinical practice can improve anesthesiologists' ability to anticipate and manage DL.