Validity Of Ultrasound As Regards Correlation To Cormack-Lehane Grading In Obese Patients

Study Overview
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Brief Summary
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Since the introduction of real-time ultrasound (US) capabilities, ultrasound technology has been adopted and incorporated into daily practice by many medical and surgical specialties. Using US to help assess the difficult airway constitutes just yet another valuable application of this versatile technology . Since many anesthesia providers had already acquired proficiency in US techniques in US guided vascular access and regional nerve blocks, using US to evaluate the airway could be learned and mastered without too much difficulty. Ultrasound of the upper airway may prove to become a useful adjunct to conventional clinical assessment tools, as it has been successful in visualizing the relevant anatomy and critical structures of the airway..

Detailed Description
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The study is cross sectional observational study in which obese patients will be assessed using conventional clinical methods of airway assessment and by using US for the same patient before induction of anesthesia then correlated to the Cormack-Lehane finding after induction of anesthesia..

Official Title
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Validity Of Ultrasound As Regards Correlation To Cormack-Lehane Grading In Obese Patients: A Cross Sectional Observational Study

Conditions
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Difficult Airway Intubation

Intervention / Treatment
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* Device: Assessing validity of ultrasound as regards correlation to Cormack-Lehane grading in obese patients


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age of the patient : (21-60) years old. Sex : male & female. Physical Status : The American Society of Anesthesiologists (ASA) II-III patients. Body mass index : 30 to more than 30 kg / m² . Operations: Laparoscopic surgeries,bariatric surgeries and any operation that requires general anesthesia with endotracheal tube placement . Exclusion Criteria: Patient refusal. Deformity of the airway anatomy [by masses or tumors]. Patients with thyroid swellings 'Goitre'. Pathology of the airway [edema,burn and arthritis].

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 60 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| obese patients<br>compare between ultrasonography and conventional clinical methods of airway assessment prior to induction of anesthesia correlating it to the Cormack-Lehane scoring system after induction of anesthesia in obese patients | Device: Assessing validity of ultrasound as regards correlation to Cormack-Lehane grading in obese patients<br>* Assessing validity of ultrasound as regards correlation to Cormack-Lehane grading in obese patients<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The ratio of the depth of the pre-epiglottic space (Pre-E) to the distance from the epiglottis to the mid-point of the distance between the vocal cords (E-VC). | If It is [0-1] ,this suspects Cormack-Lehane Grade 1.If it is [1-2],this suspects Cormack-Lehane Grade 2.If it is [2-3],this suspects Cormack-Lehane Grade 3 | through study completion, an average of 1 year | 
| The anterior neck soft tissue thickness at the level of the vocal cords (ANS-VC) | ANS-VC >0.23 cm had a sensitivity of 85.7% in predicting a Cormack-Lehan Grade 3 or 4 | through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The anterior neck soft tissue thickness at the level of the hyoid bone (ANS-Hyoid) | If it is 1.69 cm [1.19 cm to 2.19 cm],this suspects difficult laryngoscopy.If it is 1.37cm [1.27 cm to 1.46 cm], this suspects easy laryngoscopy | through study completion, an average of 1 year | 
| The hyomental distance of the patient in neutral position of the neck and in fully extended neck calculating the ratio between both of them | If The mean hyomental distance ratios is (1.02 ± 0.01) ,this suspects difficult intubation.If it is (1.14 ± 0.02) ,this suspects easy intubation | through study completion, an average of 1 year | 
| Tongue volume will be derived from multiplication of the midsagittal cross-sectional area of the tongue by its width obtained from transverse sonograms | Large tongue volume suspects difficult laryngoscopy | through study completion, an average of 1 year | 
| Modified Mallampati classification | Class I is visualization of the hard palate, soft palate, fauces, uvula, and pillars. Class II is visualization of the hard palate, soft palate, fauces, and base of uvula. Class III is visualization of the hard palate and soft palate. Class IV is visualization of only the hard palate | through study completion, an average of 1 year | 
| Interincisor gap | If it is less than 5 cm (approximately three finger breadths) with limited forward protrusion of the mandible ,this is associated with increased risk of difficult laryngoscopy | through study completion, an average of 1 year | 
| Thyromental distance | If < 6cm ,this predicts difficult laryngoscopy | through study completion, an average of 1 year | 
| Sternomental distance | If < 12.5 cm ,this predicts difficult laryngoscopy | through study completion, an average of 1 year | 
| Neck Extension and Flexion | inability to extend or flex the neck suspects difficult laryngoscopy | through study completion, an average of 1 year |