Airway Ultrasound as a Predictor for Postextubation Stridor in Anterior Cervical Spine Surgery

Study Overview
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Brief Summary
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literature on use of the ultrasound (US) in extubation decisions in cervical spine surgery is scarce.The aim of this study will be to evaluate the utility of US as an aid for decision making for extubation in elective cervical spine surgery (anterior approach) operations and as a predictor for postextubation stridor in these operations

Official Title
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Airway Ultrasound as a Predictor for Postextubation Stridor in Cervical Spine Surgery [Anterior Approach]: Prospective Observational Study

Conditions
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Postextubation Stridor

Intervention / Treatment
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* Radiation: Airway Ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: surgeries associated with either exposure of more than three vertebral bodies, exposures involving the C2-C4 levels, blood loss exceeding 300 mL surgical time of more than five hours, Exclusion Criteria: laryngotracheobronchial pathology, severe cardiorespiratory disease, admitted for redo-surgery intubated prior to operation Patient with anesthetic risk factors include Mallampati 3 or 4 and multiple intubation attempts

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Radiation: Airway Ultrasound|Laryngeal US will be performed with a 12 megahertz (MHz) linear probe attached to the ultrasound device. With the probe placed transversely on the midline of the anterior neck over the cricothyroid membrane.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the correlation between the post procedural laryngeal air-column width difference [LACWD] as obtained by laryngeal US with occurrence of postextubation stridor | At the end of operation, laryngeal air column width [which is defined as the width of air between the vocal cords as demonstrated by US] will be obtained while the tube cuff is inflated then while it is deflated for three consecutive respiratory cycles after gentle suction of oropharyngeal airway. The laryngeal air-column width difference [LACWD] (the difference between width at balloon-cuff deflation and at balloon-cuff inflation) will be obtained and the average value will be recorded. Patient will be considered ready for extubation after performance of the cuff-leak test as [the volume of reduced cuff leak test is more than 110 ml] then reversal of neuromuscular blockade will be done. They tube will be removed when the patients can open their eyes on verbal commands and the T4/T1 ratio is 90% or more. After transferal of patients ICU where they will be observed for occurrence of postextubation stridor in the first 6 hour postoperatively. | First 6 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of other airway complication as hematoma |  | Intraoperative pre-extubation |