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Updated: Mar 1, 2026
Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways
Published on: April 7, 2023
Evaluation of difficult laryngoscopy with ultrasonography in pediatric patients: Prospective study
Osman Kaya1, Sema Şanal2, Meryem Onay3
1Department of Anesthesiology and Intensive Care, Southend University Hospital, Essex, United Kingdom.
Insights
Ultrasonography did not predict difficult laryngoscopy (DL) in pediatric patients. The Mallampati score, however, showed a correlation with DL, indicating its utility in predicting challenging pediatric airways.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Medical Imaging
Background:
- Effective airway management is crucial in pediatric anesthesia.
- Difficult laryngoscopy (DL) presents unique challenges in children due to anatomical differences.
- Predictive tools for DL are essential for safe pediatric intubation.
Purpose of the Study:
- To assess the efficacy of preoperative upper airway ultrasonographic measurements in predicting DL in pediatric patients.
- To evaluate specific measurements like hyoid bone-to-skin distance (DSHB), epiglottis-to-skin distance (DSE), and vocal cord anterior commissure-to-skin distance (DSAC), and their ratio.
- To compare ultrasonography with the Mallampati score for DL prediction.
Main Methods:
- A prospective study involving 121 pediatric patients aged 2-8 years undergoing general anesthesia.
- Preoperative ultrasonographic measurements (DSHB, DSE, DSAC) and the DSAC/DSE ratio were recorded.
- Laryngoscopy difficulty was classified using the Cormack-Lehane (CL) scale; grades 3-4 defined DL. Mallampati scores were also assessed.
Main Results:
- Only 6 out of 121 patients experienced DL.
- No significant correlation was found between any ultrasonographic measurements (DSHB, DSE, DSAC, DSAC/DSE ratio) and the Cormack-Lehane classification of DL.
- The Mallampati score demonstrated a positive correlation with higher DL grades and was identified as a predictor of DL.
Conclusions:
- Preoperative upper airway ultrasonographic measurements are not effective predictors of DL in pediatric patients.
- The Mallampati score remains a valuable clinical tool for predicting DL in this population.
- Further research is needed to develop reliable ultrasonographic predictive models for pediatric DL.
Abstract:
Effective airway management is a critical aspect of anesthesia, with difficult laryngoscopy (DL) posing significant challenges, particularly in pediatric patients, due to anatomical and physiological differences. This study aimed to evaluate the utility of ultrasonographic measurements of the upper airway as predictors of DL in children. Pediatric patients aged 2 to 8 years who underwent endotracheal intubation under general anesthesia were included. According to the Cormack-Lehane classification (CL), grades 3 and 4 are defined as difficult laryngoscopies. Preoperative ultrasonographic measurements of the hyoid bone-to-skin distance (DSHB), epiglottis-to-skin distance (DSE), and vocal cord anterior commissure-to-skin distance (DSAC) were obtained. The DSAC/DSE ratio was calculated and its potential for predicting DL was assessed. A total of 121 pediatric patients were included in the final analysis, and 6 patients had DL. This study found no correlation between ultrasonographic measurements and the difficulty of laryngoscopy, as classified by the CL score. However, the Mallampati score was a predictor of DL and showed a positive correlation with higher difficulty grades. In this study, the effectiveness of DSHB, DSAC, DSE measurements, and the DSAC/DSE ratio in predicting DL in pediatric patients was evaluated; however, no significant correlation was found. Further research is needed to validate these findings and improve predictive models for difficult pediatric airway management.
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