Role of Ultrasonography in Airway Management

Is There a Role for Ultrasonography in the Airway Management of Patients With Obesity

Ultrasound is one of the most useful devices in daily anesthesia practice. Latest purpose of ultrasound usage is prediction of difficult intubation. In this study, we aimed to predict difficult laryngoscopy and intubation by using ultrasound measurement of neck soft tissue thickness in obese patient preoperatively.

Study Overview

• Status: Unknown
• Conditions: Obese Patients

Detailed Description

In this prospective and randomized controlled study, mallampati scores, interincisor gap, thyromental distance, neck circumference measurement and upper lip bite test scores will be recorded in sixty obese patients.

Additionally, neck tissue thickness will be recorded at 4 different levels (hyoid bone-skin distance, epiglot-skin distance , thyroid istmus-skin distance, vocal cord-skin distance) after the sniffing position by ultrasound with the linear probe. All measurements will be repeated three times and an average values will be recorded.

After all this measurements, endotracheal intubation will be performed by an experienced anesthetist who is uninformed about study. During intubation the Cormack Lehane (C/L, grade 1: full view of the vocal cords; grade 2a: partial view of the glottis; 2b: posterior part of the vocal cord and arytenoids visible; grade 3: only epiglottis visible; and grade 4: neither epiglottis nor glottis visible) and the Intubation Difficulty Scale (IDS) score (the numbers of attempts, operators, and alternative techniques used, the C/L grade of laryngoscopic view, lifting force and external laryngeal manipulation required, and position of the vocal cords. Every insertion of the laryngoscope and advancement of the tracheal tube towards the glottis counted as an attempt. A score of >5 indicates moderate-to-major difficulty) will be recorded.

• Study Type: Observational
• Enrollment (Anticipated): 60

Contacts and Locations

• Study Contact: Name: Basak Gulel; Phone Number: 05061436261; Email: dr.basakdemir@gmail.com
• Study Contact Backup: Name: Emine Arik; Phone Number: 05333471530; Email: emineincearik@yahoo.com

Study Locations

• Turkey
  • Province
    • Ankara, Province, Turkey, 06080
      • Başak Gülel

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Patients with obesity body mass index >30 undergoing surgery and requiring tracheal intubation

Description

Inclusion Criteria:

• BMI>30
• 18-65 YEARS
• ASA 1-2-3
• Obese patients

Exclusion Criteria:

• Pregnancy
• Upper airway pathology
• Cervical spine pathology
• Laryngeal pathology

Study Plan

How is the study designed?

Design Details

• Observational Models: Other
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hyoid bone-skin distance -effect of ultrasound on prediction of difficult laryngoscopy	The hyoid bone-skin distance will be measured by using ultrasound in centimeters	30 minutes before induction
Epiglottis-skin distance	The epiglottis-skin distance will be measured by using ultrasound in centimeters	30 minutes before induction
Thyroid isthmus-skin distance	The thyroid isthmus-skin distance will be measured by using ultrasound in centimeters	30 minutes before induction
Vocal cord-skin distance	The vocal cord-skin distance will be measured by using ultrasound in centimeters	30 minutes before induction

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intubation difficulty scale score	Each number of numbers attempt, operator and alternative techniques used, the Cormack Lehane score of laryngoscopic view, lifting force and external laryngeal manipulation required, and position of the vocal cords count 1 point. A score of >5 indicates moderate-to-major difficulty	1 minutes after intubation

Collaborators and Investigators

• Sponsor: Diskapi Yildirim Beyazit Education and Research Hospital
• Investigators: Principal Investigator: Basak Gulel, Sbü Dışkapı Yıldırım Beyazıt Eğitim Ve Araştırma Hastanesi

Publications and helpful links

General Publications

• Al-Qasmi A, Al-Alawi W, Malik AM, Manzoor Khan R, Kaul N. Comparison of Tracheal Intubation Using the Storz's C-Mac D-blade(TM) Video-Laryngoscope Aided by Truflex(TM) Articulating Stylet and the Portex(TM) Intubating Stylet. Anesth Pain Med. 2015 Dec 5;5(6):e32299. doi: 10.5812/aapm.32299. eCollection 2015 Dec.
• Wu J, Dong J, Ding Y, Zheng J. Role of anterior neck soft tissue quantifications by ultrasound in predicting difficult laryngoscopy. Med Sci Monit. 2014 Nov 18;20:2343-50. doi: 10.12659/MSM.891037.
• Ezri T, Gewurtz G, Sessler DI, Medalion B, Szmuk P, Hagberg C, Susmallian S. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia. 2003 Nov;58(11):1111-4. doi: 10.1046/j.1365-2044.2003.03412.x.
• Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005 Aug;103(2):429-37. doi: 10.1097/00000542-200508000-00027.

Study record dates

Study Major Dates

• Study Start (Anticipated): November 1, 2019
• Primary Completion (Anticipated): March 1, 2020
• Study Completion (Anticipated): March 1, 2020

Study Registration Dates

• First Submitted: October 16, 2019
• First Submitted That Met QC Criteria: October 24, 2019
• First Posted (Actual): October 25, 2019

Study Record Updates

• Last Update Posted (Actual): October 25, 2019
• Last Update Submitted That Met QC Criteria: October 24, 2019
• Last Verified: October 1, 2019

More Information

Terms related to this study

• Other Study ID Numbers: BasakUltrasonografi

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No