COMPARATIVE ANALYSIS OF ULTRASONOGRAPHIC SKIN-TOEPIGLOTTIS DISTANCE (DSE) AS A PREDICTOR OF DIFFICULT INTUBATION IN OBESE AND NON-OBESE PATIENTS
Authors: Vamsi M Mohan , Agarwal Meenal , Takkalaki Nandini , Ahmed Peerzade Sayed Faheem 
Published: November 2024

Introduction: Airway management is a critical component of anesthesia practice, and successful intubation is
essential for patient safety during surgical procedures. Obesity presents unique challenges for airway management
due to altered anatomical features, such as increased soft tissue in the neck, which complicates intubation. Ultrasonographic measurement
of the Distance from Skin to Epiglottis (DSE) is a promising predictor of intubation difficulty, offering an objective tool for preoperative
airway assessment. This study aims to explore the relationship between DSE, Body Mass Index (BMI), and Cormack-Lehane (CL) grading
to determine if DSE can serve as a reliable predictor of intubation difficulty in obese and non-obese patients. Materials and Methodology:
A prospective, cross-sectional study was conducted in the Department of Anesthesiology and Critical Care at Al-Ameen Medical College,
Vijayapura, over six months. Sixty patients aged 18-60 years, classified as ASA I or II and scheduled for elective surgery under general
anesthesia, were recruited. Patients were divided equally into non-obese (BMI ≤25 kg/m²) and obese (BMI >25 kg/m²) groups.
Ultrasonographic DSE measurements were performed preoperatively, followed by intubation using direct laryngoscopy, during which the
Cormack-Lehane grading was recorded. The need for modifications during intubation, such as the BURP maneuver or the use of a bougie,
was also documented. Data analysis included Pearson's correlation to assess relationships between DSE, BMI, and CL grading. Results:
The study found that obese patients had a significantly greater DSE (mean: 2.68 cm) compared to non-obese patients (mean: 2.02 cm). A
positive correlation was observed between DSE and BMI in both groups, with a stronger correlation in non-obese patients (r = 0.782, p <
0.001) compared to obese patients (r = 0.421, p = 0.021). A strong positive correlation was also found between DSE and CL grading, with
higher DSE values associated with more challenging intubation. The correlation was more pronounced in non-obese patients (r = 0.885, p <
0.001) compared to obese patients (r = 0.734, p < 0.01). The need for modifications during intubation was significantly higher in the obese
group, with 33.3% requiring the BURP maneuver and 13.3% requiring both BURP and a bougie. Discussion and Conclusion: This study
demonstrates that ultrasonographic measurement of DSE is a reliable predictor of intubation difficulty, particularly in obese patients. The
greater DSE values in obese patients correlate with higher Cormack-Lehane grades and increased intubation difficulty. Implementing
ultrasonographic DSE assessment in routine preoperative evaluations could improve the prediction of difficult intubation, allowing for
better preparation and reduced risks during airway management. Further research is warranted to validate these findings in larger, diverse
populations and to explore additional ultrasonographic parameters for assessing airway difficulty.