Airway Ultrasound: A Narrative Review of Present Use and Future Applications in Anesthesia

Introduction: Airway management remains a high-risk intervention in a subset of patients, with traditional predictors like the Mallampati score demonstrating poor sensitivity and specificity. Point-of-care ultrasound (POCUS) has emerged as a transformative tool, offering real-time, objective assessment of airway anatomy to improve safety and outcomes. Methods: A narrative approach was conducted to evaluate the literature on airway ultrasound, incorporating clinical metrics and procedural applications. Results: Ultrasound has demonstrated utility in pre-intubation risk stratification using quantitative measures such as skin-to-epiglottis distance (>2.75 cm) and hyomental distance ratio (<1.2), which outperform traditional exams, especially in obese patients. Procedural uses include endotracheal tube confirmation with 98.9% sensitivity and enhanced success rates in emergent cricothyroidotomy-from 50% to nearly 100%-in patients with difficult anatomy. Dynamic applications like assessing laryngeal edema via parapharyngeal thickness offer advantages over traditional cuff leak tests. Technical considerations such as optimal probe selection, patient positioning, and interpretation of key anatomical landmarks are also discussed. Conclusions: Airway ultrasound is poised to become a standard tool in perioperative and critical care settings. The review concludes by emphasizing POCUS as an indispensable adjunct for modern airway management.