[Ultrasound guided airway access]

Journal of Clinical Medicine

Ultrasound is an everyday diagnostic tool. In anesthesia and intensive care, it has a role as an adjuvant for many procedures, including the evaluation of the airway. Ultrasound airway evaluation can help predict a difficult airway, visualize the proper positioning of an intubation cannula, or evaluate the airway post-intubation. Protocols need to be established for the better integration of ultrasound in the airway evaluation, however until a consensus is reached in this respect, the ultrasound is a reliable aid in anesthesia and intensive care.

Advances in Tracheal Intubation [Working Title]

The ultrasound has been in clinical use since the early 1900s, but its use in the airway has not been published extensively so far. Combining the skills of USG with thorough knowledge of regional anatomy can prove to be a boon to improving the quality of care being delivered to patients. Preoperative use of USG at different levels of the neck combined with the risk assessment methods can help to organize predictors of difficult airway and difficult laryngoscopy. Basic comprehension of USG physics, transducer selection, and probe orientation and a better understanding of airway anatomy contribute to the accuracy of ultrasound interpretation. In day-to-day practice, there is a potential for failed tracheal intubations followed by failure of gaining adequate access to the airway, thus posing challenges to anesthesiologists. Besides predicting difficult airway, USG provides an incentive to properly place an endotracheal tube (ETT) to an adequate depth, estimation of the size of ETT part...

2011

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.

Journal of Clinical Monitoring and Computing, 2020

Ultrasonography is a simple, reliable, non-invasive technique which helps in real-time assessment of airway anatomy and contributes to safer airway management in various settings like operating rooms, intensive care units and emergency departments. It also helps us to plan the appropriate anesthetic technique especially in difficult airway cases. Here, we discuss the importance of styleted tracheal tube in improving the accuracy of ultrasound guided tracheal intubation in anticipated difficult airway.

Anesthesiology, 2012

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American Journal of Emergency Medicine, 2017

International journal of recent surgical and medical science, 2022

Background The study was conducted with the aim of determining the usefulness of ultrasonography in assessment of difficult airway preoperatively to compare and correlate airway assessment done clinically and airway viewed ultra sonographically with Cormack-Lehane classification of the direct laryngoscopy. Methodology This prospective, observational trial consists of total 150 patients undergoing elective surgeries under general anesthesia. The measurements recorded were interincisor gap, modified Mallampati's classification, and thyromental distance and the airway assessment of ultrasound done. Based on the Cormack-Lehane classification of laryngoscopic view, patients were classified into different groups: group A-easy intubation and group B-difficult intubation, at the end of the study. Results In both the groups, demographic data were similar except weight, which was significant in group B. Ultrasound measurements of airway done at four levels-hyoid bone, suprasternal-notch, thyroid isthmus, and thyroid-were increased in group B compared with group A, with p-values 0.0002, 0.0001, 0.001, and 0.0001, respectively, showing significant results. Conclusion On the basis of our study, we conclude that by measuring the thickness of soft tissues in the anterior part of neck with ultrasound difficult airway can be predicted, thus ultrasound can be used for assessing difficult airway preoperatively.

Journal of Emergency and Critical Care Medicine

Point-of-care ultrasound (POCUS) has gained the upper hand for being simple, non-invasive and portable. Traditional beliefs that ultrasound is futile in the imaging of air-filled structures has been refuted. Upper airway ultrasound is applicable to patients with distorted anatomy, not easily discernable by traditional methods, besides serving as a useful adjunct peri-intubation; as a pre-intubation screening tool for difficult laryngoscopy, selection of endotracheal tube (ETT) size and confirmation of ETT placement and depth, and to detect laryngeal mask airway (LMA) malrotation. Airway ultrasound also assists in procedural guidance for percutaneous cricothyroidotomy, percutaneous dilatational tracheostomy (PDT) and airway nerve blocks by improving success rate with fewer attempts and safety. In the critical care unit, sonographic parameters of the airway provide means to predict post extubation stridor hence successful extubation, in addition to identifying upper airway pathologies. The feasibility of focused airway ultrasound also lies in its shallow learning curve and the relative ease of mastering the skill with appropriate training. The integration of upper airway ultrasound into POCUS examination may be a prelude to a bigger picture in future airway management. Increasing awareness of the practicality of this tool, availability in critical areas and improving technological advancements will encourage more usage resulting in its incorporation into routine clinical practice.

Turkish Journal of Anaesthesiology and Reanimation, 2021

The aim of this study was to evaluate and correlate ultrasound measurement of airway parameters with the Cormack-Lehane (CL) grading observed under direct laryngoscopy for prediction of difficult airway. Methods: This prospective, observational study was conducted in a tertiary care institute. Ninety-six patients were scheduled for elective surgery under general anaesthesia and tracheal intubation. They were categorised as having easy (CL grades 1, 2a, and 2b) or difficult (CL grades 3a, 3b, and 4) laryngoscopy. The sonographically measured airway parameters included anterior neck soft tissue thickness at vocal cord level (ANS-VC), hyomental distance ratio (HMDr), and tongue volume (TV). These parameters were compared and correlated with the CL grading. The statistical analysis was done using SPSS version 21.0. Results: Difficult laryngoscopy was observed in 17.7% patients. Significant difference was noted in ANS-VC 0.28 6 0.09; 0.39 6 0.12, (P < .0001) and HMDr, 1.2 6 0.09; 1.15 6 0.13, (P ¼ .006) for easy and difficult laryngoscopy, respectively. ANS-VC had a sensitivity of 78.9% and specificity of 71.1% (AUC-0.816) followed by HMDr (AUC-0.713) and TV (AUC-0.608). Combined ultrasound parameters had significantly higher AUC value (0.867). Conclusions: ANS-VC was the most significant parameter with a value of >0.29 cm being a sensitive predictor of difficult intubation. Combined sonographic parameters (ANS-VC, HMDr, and TV) were better predictors of difficult intubation.

Diagnostics

Airway management is a common and critical procedure in acute settings, such as the Emergency Department (ED) or Intensive Care Unit (ICU) of hospitals. Many of the traditional physical examination methods have limitations in airway assessment. Point-of-care ultrasound (POCUS) has emerged as a promising tool for airway management due to its familiarity, accessibility, safety, and non-invasive nature. It can assist physicians in identifying relevant anatomy of the upper airway with objective measurements of airway parameters, and it can guide airway interventions with dynamic real-time images. To date, ultrasound has been considered highly accurate for assessment of the difficult airway, confirmation of proper endotracheal intubation, prediction of post-extubation laryngeal edema, and preparation for cricothyrotomy by identifying the cricothyroid membrane. This review aims to provide a comprehensive overview of the key evidence on the use of ultrasound in airway management. Databases...