Upper Airway Ultrasound in the Assessment of Difficult Visualization of the Larynx

Study Overview
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Brief Summary
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failed and Difficult tracheal intubation after direct laryngoscopy is a dreaded complication of general anesthesia as it is associated with serious morbidity and mortality. There are several conventional clinical airway assessment parameters such as the modified Mallampati classification,thyromental and hyomental distance, interincisor distance, neck movementsand neck circumference, which are usually used to predict a difficult airwayand are components of multivariate risk indices. Despite the use of these parameters, the diagnostic accuracy of a preanesthetic airway assessment in predicting difficult intubation is very low. Ultrasound has been evolving as a useful device for airway assessment,and sublingual ultrasound has been used for this purpose.

Detailed Description
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By an anesthesiologist who is experienced in airway ultrasound, patients will preoperative sonographic assessment . the patient will lie in the ramped up position , with head in the neutral position.The linear probe of the ultrasound machine will be used. Under the patient's chin, The probe of ultrasond will be placed , at different levels, to get the of the submandibular area in transverse view and the upper part of the neck. The transverse view will be used for measuring the the skin to hyoid, tongue volume,and the skin to epiglottis distance. The mid-sagittal view will be used for measuring the distance between epiglottis ,pre-epiglottic space , vocal cords, and the neck fat volume .

Official Title
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Point of Care Upper Airway Ultrasound in the Assessment of Difficult Visualization of the Larynx in Obese Patients Undergoing Bariatric Surgery: a Comparison With the Conventional Cormack-Lehane Classification During Direct Laryngoscopy: an Observational Study

Conditions
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Airway Assessment

Intervention / Treatment
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* Radiation: sonographic assessment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients above 18 years of age. Both genders Patients scheduled for elective surgery under general anesthesia Obese patients with BMI > 30 kg/m2 Exclusion Criteria: Patients with psychological disorders or those lacking co-operation. Patients with maxillofacial anomalies, restricted neck movements and limited mouth opening. American Society of Anesthesiologists (ASA) physical status class IV Emergency operations

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: preoperative sonographic assessment group<br>preoperative sonographic assessment to airway | Radiation: sonographic assessment<br>* preoperative sonographic assessment to airway<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Epiglottis-to-vocal-cord distance | Epiglottis-to-vocal-cord distance by ultrasound | during examination up to 1 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Tongue width | by ultrasound | UP TO 1 HOURE | 
| Modified Mallampati class | Class I: Soft palate, fauces, pillars, and uvula are visible. Class II: Soft palate, fauces, and uvula are visible. Class III: Soft palate and base of uvula are visible. Class IV: Soft palate is not visible at all. Class I and II were defined as good view and III and IV as poor view in the present study. | UP TO 1 HOURE | 
| the time needed to perform the ultrasound examination. | by minute | UP TO 1 HOURE | 
| Pre-epiglottic space | by ultrasound | UP TO 1 HOURE | 
| Pre-epiglottic space | by ultrasound | up to 1 hour | 
| Skin to hyoid distance | by ultrasound | up to 1 hour | 
| Skin to epiglottis distance | by ultrasound | up to 1 hour |