Research Article

Evaluation of Ultrasound Guided Measurement of Tongue Thickness in Predicting Difficult Tracheal Intubation in Patients Undergoing Elective Surgery: A Cross Sectional Study

Abstract

Background: Preoperative airway assessment is necessary to identify airway difficulties to the earliest, ensure adequate preparation to airway management before induction and to avoid airway related complications. Various Imaging techniques have been studied for prediction of the difficult airway. the ultrasound is a quick and simple technique. Aim of the study was to evaluate ultrasound guided measurement of tongue thickness in predicting difficult tracheal intubation in patients undergoing elective surgery.
Methods: Sixty-one patients American Society of Anesthesiologist class I and II,18-65 years of age, either sex, were included. Tongue thickness was measured by ultrasound as the distance from the surface of tongue to the submental skin. Modified mallampatti score was also recorded.
Results: Receiver operating characteristic (ROC) curve of tongue thickness showed an AUC of 0.879 for a cut off value of >6 cm. This shows it has an excellent predictive value. Tongue thickness (>6cm) was found to have 90.16% combined diagnostic accuracy with 75% sensitivity and 94.74% specificity for prediction of difficult intubation. No correlation between tongue thickness and modified mallampatti score. (Correlation coefficient was 0.013, p value 0.920).
Conclusion: We conclude that ultrasound guided measurement of tongue thickness> 6 cm can reliably predict difficult tracheal intubation in patients undergoing elective surgery.

[1] Sutagatti JG, Kurdi MS. Upper airway imaging and its role in preoperative airway evaluation. Med J DY Patil Univ. 2016; 9:300-6.
[2] Gupta S, Sharma RKR, Jain D. Airway assessment: predictors of difficult airway. Indian J Anaesth. 2005; 49(4):257-62.
[3] Cook TM, MacDougall-Davis SR. Complications and failure of airway management. Br J Anaesth 2012; 109:68–85.
[4] Crawley SM, Dalton AJ. Predicting the difficult airway. BJA Educ. 2015;15(5):253-8.
[5] Naguib M, Malabarey T, AlSatli RA, Al Damegh S, Samarkandi AH. Predictive models for difficult laryngoscopy and intubation. A clinical, radiologic and three-dimensional computer imaging study. Can J Anaesth. 1999;46(8):748-59.
[6] Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015; 115(6):827-48.
[7] Yao W, Wang B. Can tongue thickness measured by ultrasonography predict difficult tracheal intubation? Br J Anaesth. 2017;118(4):601–9.
[8] Hui CM, Tsui BC. Sublingual ultrasound as an assessment method for predicting difficult intubation: a pilot study. Anaesthesia. 2014;69(4):314–9.
[9] Petrisor C, Dîrzu D, Trancă S, Hagău N, Bodolea C. Preoperative difficult airway prediction using suprahyoid and infrahyoid ultrasonography derived measurements in anesthesiology. Med Ultrason. 2019;21(1):83-88.
[10] Cherian A, Kundra P. Ultrasound imaging of the airway and its applications. Airway. 2018; 1:17-24.
[11] Adhikari S, Zeger W, Schmier C, Crum T, Craven A, Frrokaj I, et al. Pilot study to determine the utility of point-of-care ultrasound in the assessment of difficult laryngoscopy. Acad Emerg Med. 2011;18(7):754–8.
[12] Lundstrom LH, Vester-Anderson M, Moller AM, Charuluxananan S, L'hermite J, Wetterslev J. Poor prognostic value of the modified Mallampatti score: a meta-analysis involving 177088 patients. Br J Anaesth. 2011;107(5):659-67.
[13] Yadav NK, Rudingwa P, Mishra SK, Pannerselvam S. Ultrasound measurement of anterior neck soft tissue and tongue thickness to predict difficult laryngoscopy – An observational analytical study. Indian J Anaesth. 2019; 63:629-34.
[14] Jain S, kachru N, Yadav R. Evaluation of Ultrasound Guided Measurement of Anterior Neck Soft Tissue Thickness in Predicting Difficult Laryngoscopy in Obese Patients. Arch Anesth & Crit Care. 2021;7(4):216-222.
[15] Soltani Mohammadi S, Tavakkoli A, Marashi M. Correlation between Ultrasound Measured Distance from Skin to Epiglottis and Epiglottis to Mid-Vocal Cord with Cormack-Lehane Classification for Predicting Difficult Intubation. Arch Anesth & Crit Care. 2019;6(1):23-26.
[16] De Jong A, Molinari N, Pouzeratte Y, Verzilli D, Chanques G, Jung B, et al. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units. Br J Anaesth. 2015; 114(2):297-306.
[17] Agarwal R, Jain G, Agarwal A, Govil N. Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway. Korean J Anaesthesiol. 2021;74(2):134-141.
[18] Kumar AN, Halder B, Rajaram N, Rajkumar VS, Krishna H. Ultrasound guided airway assessment- an observational study to correlate airway parameter to cormack-lehane grading of laryngoscopy. Indian J Clin Anaesth. 2020;7(4):657–61.
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IssueVol 9 No 3 (2023): Summer QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v9i3.13113
Keywords
Airway Intubation Tongue Ultrasound

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How to Cite
1.
Sajitha N, Kachru N, Yadav U, Yadav R. Evaluation of Ultrasound Guided Measurement of Tongue Thickness in Predicting Difficult Tracheal Intubation in Patients Undergoing Elective Surgery: A Cross Sectional Study. Arch Anesth & Crit Care. 2023;9(3):201-205.