• Airway
• anesthesia
• clinical
• sonographic
• ultrasound

• Anaesthesia
• difficult airway
• imaging
• radiology

• Adult
• Airway Resistance
• Dilatation/instrumentation
• Dilatation/methods
• Female
• Healthy Volunteers
• Humans
• Male
• Motion
• Movement
• Respiratory Mechanics/physiology
• Ultrasonography

• Airway
• Intubation
• Laryngoscopy
• Ultrasonography

Difficult tracheal intubation is associated with serious morbidity and mortality and cannot be always predicted based on preoperative airway assessment using conventional clinical predictors. Ultrasonographic airway assessment could be a useful adjunct, but at present, there are no well-defined sonographic criteria that can predict the possibility of encountering a difficult airway. The present study was conducted with the aim of finding some correlation between preoperative sonographic airway assessment parameters and the Cormack–Lehane (CL) grade at laryngoscopic view in adult patients.

This was a prospective, double-blinded study on 130 patients undergoing elective surgery under general anesthesia. Preoperative clinical and ultrasonographic assessment of the airway was done to predict difficult intubation and was correlated with the CL grade noted at laryngoscopy. The sensitivity, specificity, positive predictive value, and negative predictive values of the parameters were assessed.

The incidence of difficult intubation was 9.2%. Among the clinical predictors, the modified Mallampati classification had the maximum sensitivity and specificity, and among the sonographic parameters, the skin to epiglottis distance had the maximum sensitivity and specificity to predict difficult laryngoscopy. A combination of these two tests improved the sensitivity in predicting a difficult laryngoscopy.

The skin to epiglottis distance, as measured at the level of the thyrohyoid membrane, is a good predictor of difficult laryngoscopy. When combined with the modified Mallampati classification, the sensitivity of the combined parameter was found to be greater than any single parameter taken alone.

• Airway
• assessment
• laryngoscopy
• ultrasonography

• Airway
• Airway management
• Assessment
• Intubation
• Laryngoscopy
• Techniques
• Tracheal

Airway evaluation and its management remains an ever emerging clinical science. Present airway management tools are static and do not provide dynamic airway management option. Visualized procedures like ultrasound (US) provide point of care real time dynamic views of the airway in perioperative, emergency and critical care settings. US can provide dynamic anatomical assessment which is not possible by clinical examination alone. US aids in detecting gastric contents and the nature of gastric contents (clear fluid, thick turbid or solid) as well. US can help in predicting endotracheal tube size by measuring subglottic diameter and diameter of left main stem bronchus. US was found to be a sensitive in detecting rotational malposition of LMA in children. Also, US is the fastest and highly sensitive tool to rule out a suspected intraoperative pneumothorax. In intensive care units, US helps torule out causes of inadequate ventilation, determine the tracheal width and distance from the skin to predict tracheotomy tube size and shape and assist with percutaneous dilatational tracheostomy. US can help in confirming the correct tracheal tube placement by dynamic visualisation of the endotracheal tube insertion, widening of vocal cords (children), and bilateral lung-sliding and diaphragmatic movement. Thus, ultrasonography has brought a paradigm shift in the practise of airway management. With increasing awareness, portability, accessibility and further sophistication in technology, it is likely to find a place in routine airway management. We are not far from the time when all of us will be carrying a pocket US machine like stethoscopes to corroborate our clinical findings at point of care.

• Airway
• Ultrasound
• Evaluation
• Difficult
• Management

The scope of ultrasound is emerging in medical science, particularly outside traditional areas of radiology practice.

We designed this study to evaluate feasibility of bedside sonography as a tool for airway assessment and to describe sonographic anatomy of airway.

A prospective, clinical study.

We included 100 adult, healthy volunteers of either sex to undergo airway imaging systemically starting from floor of the mouth to the sternal notch in anterior aspect of neck by sonography.

We could visualize mandible and hyoid bone as a bright hyperechoic structure with hypoechoic acoustic shadow underneath. Epiglottis, thyroid cartilage, cricoid cartilage, and tracheal rings appeared hypoechoic. Vocal cords were visualized through thyroid cartilage. Interface between air and mucosa lining the airway produced a bright hyperechoic linear appearance. Artifacts created by intraluminal air prevented visualization of posterior pharynx, posterior commissure, and posterior wall of trachea.

Ultrasound is safe, quick, noninvasive, repeatable, and bedside tool to assess the airway and can provide real-time dynamic images relevant for several aspects of airway management.

• Airway
• sonography
• ultrasound

• airway management
• intubation
• intratracheal
• tracheostomy
• pneumothorax
• ultrasonography

Currently, the role of ultrasound (US) in anaesthesia-related airway assessment and procedural interventions is encouraging, though it is still ill defined. US can visualise anatomical structures in the supraglottic, glottic and subglottic regions. The floor of the mouth can be visualised by both transcutaneous view of the neck and also by transoral or sublinguial views. However, imaging the epiglottis can be challenging as it is suspended in air. US may detect signs suggestive of difficult intubation, but the data are limited. Other possible applications in airway management include confirmation of correct endotracheal tube placement, prediction of post-extubation stridor, evaluation of soft tissue masses in the neck prior to intubation, assessment of subglottic diameter for determination of paediatric endotracheal tube size and percutaneous dilatational tracheostomy. With development of better probes, high-resolution imaging, real-time picture and clinical experience, US has become the potential first-line noninvasive airway assessment tool in anaesthesia and intensive care practice.

• Airway
• ultrasonography
• upper respiratory tract

Difficult airway continued to be a major cause of anesthesia-related morbidity and mortality. Successful airway management depends on direct laryngoscopy and tracheal intubation. Difficult laryngoscopy is a resultant of incomplete structural arrangements during the process of head positioning. Through clinical history, examination of the patients along with craniofacial indices alerts the anesthetist for difficult laryngoscopy. But it does not predict all causes of difficult laryngoscopy during pre-anesthetic evaluation. The maxillo-pharyngeal angle, an upper airway anatomical balance, was proposed for better understanding the pathophysiology of difficult laryngoscopy. In our study we have assess difficult laryngoscopy by electronically measuring maxillo-pharyngeal angles on a lateral cervical radiograph. This angle is normally greater than 100°. Less than 90° angle suggests either impossible or difficult direct laryngoscopy when all known craniofacial indices were within the normal range. Cervical radiographic assessment is a simple, economical, and non-invasive predictive method for difficult laryngoscopy. It should be used routinely along with other indices as pre-anesthetic airway assessment criteria to predict the difficult laryngoscopy.

Difficulties with airway management continue to be a major cause of anesthesia-related morbidity, mortality, and litigation. Pre-operative assessment of difficult laryngoscopy by the simple and non-invasive radiological method can help to prevent them.

To assess the difficult laryngoscopy pre operatively by a simple and non invasive radiological method by electronically measuring maxillo-pharyngeal angle on a lateral cervical radiograph and it’s correlation with Cormack and Lehane grading.

This is a controlled, nonrandomized, prospective, cohort observation study.

The 157 adult consented patients of ASA grade I to III of either sex, scheduled for elective surgery under general anesthesia with endo-tracheal intubation, were studied. The patients with identified difficult airway indices were excluded from the study. The maxillo-pharyngeal angle was electronically measured on a lateral cervical radiograph and was correlated with ease or difficulty of laryngoscopy under general anesthesia. Their degree of laryngeal exposure according to Cormack and Lehane classification grade was also noted.

We performed univariate analyses to evaluate the association between the covariates and direct laryngoscopy.

In 148 patients (94.28%), the maxillo-pharyngeal angle was more than 100°, in 7 patients (4.45%) it was less than 90°, and in 2 patients (1.27%) the M-P angle was less than 85° with normal craniofacial indices. When the MP angle was less than 90°, the direct laryngoscopy was difficult which could be compared with to Cormack and Lehane classification grade III and IV.

Lateral cervical radiographic assessment should be used as pre-anesthetic airway assessment criteria to predict the difficult laryngoscopy as it is a simple, safe and non-invasive method.

• Cormack and Lehane grade
• Maxillo-pharyngeal angle
• cervical radiograph
• electronic measurement of angle
• laryngoscopy

• Female
• Humans
• Male
• Middle Aged
• Neck/diagnostic imaging
• Pilot Projects
• Prospective Studies
• Reference Values
• Respiratory System/diagnostic imaging
• Tomography, X-Ray Computed/methods
• Ultrasonography

• Airway assessment
• anesthesia
• intensive care
• nerve block
• regional anesthesia
• ultrasound
• vascular access

• Brachial Plexus/diagnostic imaging
• Epiglottis/diagnostic imaging
• Humans
• Intubation, Intratracheal
• Larynx/diagnostic imaging
• Neck/diagnostic imaging
• Nerve Block
• Otorhinolaryngologic Surgical Procedures/methods
• Pharynx/diagnostic imaging
• Respiratory System/diagnostic imaging
• Tracheostomy
• Ultrasonography/methods

• Female
• Humans
• Larynx/diagnostic imaging
• Male
• Mouth/diagnostic imaging
• Reproducibility of Results
• Sensitivity and Specificity
• Trachea/diagnostic imaging
• Ultrasonography/methods
• Young Adult

• Anesthesiology/methods
• Humans
• Intubation, Intratracheal/methods
• Mouth Floor/anatomy & histology
• Mouth Floor/diagnostic imaging
• Respiratory System/anatomy & histology
• Respiratory System/diagnostic imaging
• Ultrasonography