Evaluation of Difficult Laryngoscopy With Ultrasonography in Pediatric Patients

Study Overview
=================
Brief Summary
-----------------
Pediatric patients pose challenges in airway management due to anatomical and physiological changes. Using recommended predictive tests for predicting difficult airway can be improved by combining them with ultrasound measurement of the anterior soft tissues of the neck. In this study, the investigators aim to evaluate the ultrasound measurement of anterior neck soft tissues in paediatric patients before anesthesia induction, to anticipate difficult laryngoscopy.

Detailed Description
-----------------
Eligible participants for this study will be patients aged 2-8 years scheduled for elective surgery under general anesthesia who have provided informed consent. During the preoperative evaluation, demographic data and airway physical examination results (Mallampati score) of the patients will be recorded. Patients who have received preoperative sedation will be positioned supine on the operating table, and ultrasound-guided measurements of soft tissue distances will be taken using a linear probe with a frequency range of 6-13 Hz. The distance between the hyoid bone and skin (DSHB), distance between the vocal cord anterior commissure and skin (DSAC), and distance between the epiglottis and skin (DSE) will be measured. The A/E (Anterior Commissura/Epiglottis) ratio will be calculated after measurements. After standard monitoring and anesthesia induction, difficult laryngoscopy will be evaluated using the Modified Cormack Lehane Score, which grades the visibility of vocal cords and glottic structures. A grade of 3 or 4 on this scale will be considered as difficult laryngoscopy and recorded as such. Tracheal intubation will be performed by an anesthesiologist with at least two years of experience who is unaware of the ultrasound measurements.

Official Title
-----------------
Evaluation of Difficult Laryngoscopy With Ultrasonography in Pediatric Patients

Conditions
-----------------
Intubation; Difficult or Failed, Difficult Laryngoscopy

Intervention / Treatment
-----------------
* Diagnostic Test: Distance between Skin-Hyoid Bone(DSHB)
* Diagnostic Test: Distance between Skin-Vocal Cord Anterior Commissura(DSAC)
* Diagnostic Test: Distance between Skin-Epiglottic(DSE)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients planned to undergo general anesthesia for elective surgery American Anesthesiology Association physical classification (ASA) status I-III Body mass index (BMI) above 30 Exclusion Criteria: Patients with a history of difficult airway or with conditions that are known to be associated with a difficult airway, such as syndromic or metabolic diseases. Patients with congenital maxillofacial defects. Patients with tracheal or laryngeal pathology. Patients with pulmonary diseases such as bronchial asthma or airway hyperreactivity. Patients with allergies to ultrasound gel. Patients with weight percentile outside the range of 10-90 percentiles. Patients undergoing emergency surgery.

Ages Eligible for Study
-----------------
Minimum Age: 2 Years
Maximum Age: 8 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 2-8 Years Paediatric Patients<br>During the preoperative evaluation, demographic data and airway physical examination results (Mallampati score) of the patients will be recorded. Patients who have received preoperative sedation will be positioned supine on the operating table, and ultrasound-guided measurements of soft tissue distances will be taken using a linear probe with a frequency range of 6-13 Hz. The distance between the hyoid bone and skin (DSHB), distance between the vocal cord anterior commissure and skin (DSAC), and distance between the epiglottis and skin (DSE) will be measured. The A/E (Anterior Commissura/Epiglottis) ratio will be calculated after measurements. After standard monitoring and anesthesia induction, difficult laryngoscopy will be evaluated using the Modified Cormack Lehane Score, which grades the visibility of vocal cords and glottic structures. A grade of 3 or 4 on this scale will be considered as difficult laryngoscopy and recorded as such. | Diagnostic Test: Distance between Skin-Hyoid Bone(DSHB)<br>* Hyoid bone-skin distance Other Name: DSHB<br>Diagnostic Test: Distance between Skin-Vocal Cord Anterior Commissura(DSAC)<br>* Vocal cord anterior commissura-skin distance Other Name: DSAC<br>Diagnostic Test: Distance between Skin-Epiglottic(DSE)<br>* Skin-epiglottic distance Other Name: DSE<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Difficult laryngoscopy | As the primary outcome, correlation of distance between the hyoid bone and skin (DSHB), distance between the vocal cord anterior commissure and skin (DSAC), and distance between the epiglottis and skin (DSE) and A/E (Anterior Commissura/Epiglottis) ratio with the Cormack Lehane score will be evaluated. | 1 minute | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Difficult laryngoscopy, Ultrasonography, Pediatric Airway