Journal of Surgery Concepts & Practice >

2024 , Vol. 29 >Issue 02: 156 - 160

DOI: https://doi.org/10.16139/j.1007-9610.2024.02.11

Original article

Application of ultrasonic measurement in evaluating difficult laryngoscopy exposure of OSAHS patients

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  • Department of Anesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received date: 2023-10-10

  Online published: 2024-07-01

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Abstract

Objective To explore the feasibility of ultrasonic measurement of the skin to hyoid bone distance, skin to epiglottis distance and skin to anterior commissure of vocal cords distance for predicting difficult laryngoscopy exposure in obstructive sleep apnea hypopnea syndrome(OSAHS) patients. Methods One hundred and fifty OSAHS patients with ASA Ⅰ-Ⅲ level, who underwent elective uvulopalatopharyngoplasty(UPPP) surgery under general anesthesia,were analyzed. Rountine airway assessment (Mallampati classification) and ultrasound measurement of the skin to hyoid bone distance, skin to epiglottis distance and skin to anterior commissure of vocal cords distance were performed before anesthesia. Intubation under direct laryngoscopy and the classification of laryngoscopy exposure was recorded. Cormack-Lehane classification Ⅲ-Ⅳ grade was defined as difficult laryngoscopy exposure. According to the classification results, patients were divided into two groups: non-difficult laryngoscopy exposure group and difficult laryngoscopy exposure group. We analyzed and compared the Malampati grading and ultrasound measurements between two groups. The receiver operating characteristic(ROC) curve and the optimal cut-off point of ultrasonic measurements were calculated. The effects of different methods for predicting difficult laryngoscopy exposure were analyzed. Results The proportion of cases whose Mallampati airway classification grade>Ⅱ in difficult laryngoscopy exposure group was significantly more than that in non-difficult laryngoscopy exposure group (P<0.05).The skin to hyoid bone distance and skin to epiglottis distance in difficult laryngoscopy exposure group were significantly longer than those in non-difficult laryngoscopy exposure group (P<0.05). The optimal cut-off point of the skin to hyoid bone distance and skin to epiglottis distance were 1.12 cm and 2.23 cm respectively. There was no significant difference in the skin to anterior commissure of vocal cords distance between two groups. Conclusion Ultrasound measurement of the skin to hyoid bone distance and skin to epiglottis distance had a good predictive value in difficult laryngoscopy exposure of the OSAHS patients.

Key words： Ultrasonic measurement; Difficult airway; Difficult laryngoscopy exposure; Obstructive sleep apnea hypopnea syndrome(OSAHS)

Cite this article

LI Yuanyuan, JIN Chenyu, FANG Shudong, ZHI Yankang . Application of ultrasonic measurement in evaluating difficult laryngoscopy exposure of OSAHS patients[J]. Journal of Surgery Concepts & Practice, 2024 , 29(02) : 156 -160 . DOI: 10.16139/j.1007-9610.2024.02.11

References

[1] JORDAN A S, MCSHARRY D G, MALHOTRA A. Adult obstructive sleep apnoea[J]. Lancet, 2014, 383(9918):736-747.
[2] GOTTLIEB D J, PUNJABI N M. Diagnosis and management of obstructive sleep apnea: a review[J]. JAMA, 2020, 323(14):1389-1400.
[3] SENARATNA C V, PERRET J L, LODGE C J, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review[J]. Sleep Med Rev, 2017, 34(8):70-81.
[4] OPPERER M, COZOWICZ C, BUGADA D, et al. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the society of anesthesia and sleep medicine task force on preoperative preparation of patients with sleep-disordered breathing[J]. Anesth Analg, 2016, 122(5):1321-1334.
[5] APFELBAUM J L, HAGBERG C A, CONNIS R T, et al. 2022 American society of anesthesiologists practice guidelines for management of the difficult airway[J]. Ane-sthesiology, 2022, 136(1):31-81.
[6] ZHENG Z, WANG X, DU R, et al. Effectiveness of ultrasonic measurement for the hyomental distance and distance from skin to epiglottis in predicting difficult laryngoscopy in children[J]. Eur Radiol, 2023, 33(11):7849-7856.
[7] COZOWICZ C, MEMTSOUDIS S G. Perioperative ma-nagement of the patient with obstructive sleep apnea: a narrative review[J]. Anesth Analg, 2021, 132(5):1231-1243.
[8] RAMACHANDRAN S K, PANDIT J, DEVINE S, et al. Postoperative respiratory complications in patients at risk for obstructive sleep apnea: a single-institution cohort study[J]. Anesth Analg, 2017, 125(1):272-279.
[9] KHETERPAL S, HEALY D, AZIZ M F, et al. Incidence, predictors, and outcome of difficultmask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group[J]. Anesthesiology, 2013, 119(6):1360-1369.
[10] SEET E, NAGAPPA M, WONG D T. Airway management in surgical patients with obstructive sleep apnea[J]. Anesth Analg, 2021, 132(5):1321-1327.
[11] CHOU H C, TSENG W P, WANG C H, et al. Tracheal rapid ultrasound exam (T.R.U.E.) for confirming endotracheal tube placement during emergency intubation[J]. Resuscitation, 2011, 82(10):1279-1284.
[12] KIM E J, KIM S Y, KIM W O, et al. Ultrasound measurement of subglottic diameter and an empirical formula for proper endotracheal tube fitting in children[J]. Acta Anaesthesiol Scand, 2013, 57(9):1124-1130.
[13] BAE J Y, BYON H J, HAN S S, et al. Usefulness of ultrasound for selecting a correctly sized uncuffed tracheal tube for paediatric patients[J]. Anaesthesia, 2011, 66(11):994-998.
[14] BAIR A E, CHIMA R. The inaccuracy of using landmark techniques for cricothyroid membrane identification: a comparison of three techniques[J]. Acad Emerg Med, 2015, 22(8):908-914.
[15] SIDDIQUI N, ARZOLA C, FRIEDMAN Z, et al. Ultrasound improves cricothyrotomy success in cadavers with poorly defined neck anatomy: a randomized control trial[J]. Anesthesiology, 2015, 123(5):1033-1041.
[16] RAJAJEE V, WILLIAMSON C A, WEST B T. Impact of real-time ultrasound guidance on complications of percutaneous dilatational tracheostomy:a propensity score analysis[J]. Crit Care, 2015, 14(5):130-146.
[17] SUTHERASAN Y, THEERAWIT P, HONGPHANUT T, et al. Predicting laryngeal edema in intubated patients by portable intensive care unit ultrasound[J]. J Crit Care, 2013, 28(5):675-680.
[18] EZRI T, GEWURTZ G, SESSLER D I, et al. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue[J]. Anaesthesia, 2003, 58(11):1111-1114.
[19] 陈珏旻, 蔡美华. 超声测量颈前软组织厚度用于困难喉镜暴露预测分析[J]. 中国口腔颌面外科杂志, 2019, 17(1):48-52.
  CHEN J M, CAI M H. Prediction of difficult laryngoscopy using ultrasound measurement of anterior neck structure[J]. China J Oral Maxillofac Surg, 2019, 17(1):48-52.
[20] ABRAHAM S, HIMARANI J, MARY NANCY S, et al. Ultrasound as an assessment method in predicting difficult intubation:a prospective clinical study[J]. J Maxillofac Oral Surg, 2018, 17(4):563-569.
[21] 刘春红, 陈序. 超声测量评估阻塞性睡眠呼吸暂停低通气综合征患者困难气道的价值[J]. 临床麻醉学杂志, 2020, 36(4):334-337.
  LIU C H, CHEN X. Evaluation of difficult airway in patients with obstructive sleep apnea hypopnea syndrome by ultrasonography[J]. J Clin Anesthesiol, 2020, 36(4):334-337.
[22] FALCETTA S, CAVALLO S, GABBANELLI V, et al. Evaluation of two neck ultrasound measurements as predictors of difficult direct laryngoscopy: a prospective observational study[J]. Eur J Anaesthesiol, 2018, 35(8):605-612.
[23] PINTO J, CORDEIRO L, PEREIRA C, et al. Predicting difficult laryngoscopy using ultrasound measurement of distance from skin to epiglottis[J]. J Crit Care, 2016, 33(6):26-31.
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