Ultrasound of the airway
Pankaj Kundra, Sandeep Kumar Mishra, Anathakrishnan Ramesh, Pankaj Kundra, Sandeep Kumar Mishra, Anathakrishnan Ramesh
Abstract
Currently, the role of ultrasound (US) in anaesthesia-related airway assessment and procedural interventions is encouraging, though it is still ill defined. US can visualise anatomical structures in the supraglottic, glottic and subglottic regions. The floor of the mouth can be visualised by both transcutaneous view of the neck and also by transoral or sublinguial views. However, imaging the epiglottis can be challenging as it is suspended in air. US may detect signs suggestive of difficult intubation, but the data are limited. Other possible applications in airway management include confirmation of correct endotracheal tube placement, prediction of post-extubation stridor, evaluation of soft tissue masses in the neck prior to intubation, assessment of subglottic diameter for determination of paediatric endotracheal tube size and percutaneous dilatational tracheostomy. With development of better probes, high-resolution imaging, real-time picture and clinical experience, US has become the potential first-line noninvasive airway assessment tool in anaesthesia and intensive care practice.
Keywords: Airway; ultrasonography; upper respiratory tract.
Conflict of interest statement
Conflict of Interest: None declared
Figures
References
- Sustic A. Role of ultrasound in the airway management of critically ill patients. Crit Care Med. 2007;3:173–7.
- Singh M, Chin KJ, Chan VW, Wong DT, Prasad GA, Yu E. Use of sonography for airway assessment: An observational study. J Ultrasound Med. 2010;29:79–85.
- Tsui BC, Hui CM. Sublingual airway ultrasound imaging. Can J Anaesth. 2008;55:790–1.
- Tsui BC, Hui CM. Challenges in sublingual airway ultrasound interpretation. Can J Anaesth. 2009;56:393–4.
- Raphael DT, Conard FU., 3rd Ultrasound confirmation of endotracheal tube placement. J Clin Ultrasound. 1987;15:459–62.
- Hatfield A, Bodenham A. Portable ultrasonic scanning of the anterior neck before percutaneous dilatational tracheostomy. Anaesthesia. 1999;54:660–3.
- Sustić A, Kovac D, Zgaljardić Z, Zupan Z, Krstulović B. Ultrasound-guided percutaneous dilatational tracheostomy: A safe method to avoid cranial misplacement of the tracheostomy tube. Intensive Care Med. 2000;26:1379–81.
- Orr JA, Stephens RS, Mitchell VM. Ultrasound-guided localization of the trachea. Anaesthesia. 2007;62:972–3.
- Lakhal K, Delplace X, Cottier JP, Tranquart F, Sauvagnac X, Mercier C, et al. The feasibility of ultrasound to assess subglottic diameter. Anaesth Analg. 2007;104:611–4.
- Ezri T, Gewurtz G, Sessler DI, Medalion B, Szmuk P, Hagberg C, et al. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia. 2003;58:1111–4.
- Ding LW, Wang HC, Wu HD, Chang CJ, Yang PC. Laryngeal ultrasound: A useful method in predicting post-extubation stridor. A pilot study. Eur Respir J. 2006;27:384–9.
- Shibasaki M, Nakajima Y, Ishii S, Shimizu F, Shime N, Sessler DI. Prediction of pediatric endotracheal tube size by ultrasonography. Anesthesiology. 2010;113:819–24.
- Sustić A, Miletić D, Protić A, Ivancić A, Cicvarić T. Can ultrasound be useful for predicting the size of a left double-lumen bronchial tube? Tracheal width as measured by ultrasonography versus computed tomography. J Clin Anesth. 2008;20:247–52.
- Hatfield A, Bodenham A. Ultrasound: An emerging role in anaesthesia and intensive care. Br J Anaesth. 1999;83:789–800.
- Green JS, Tsui BC. Applications of ultrasonography in ENT: Airway assessment and nerve blockade. Anesthesiol Clin. 2010;28:541–53.
- Lichtenstein D, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill: Lung sliding. Chest. 1995;108:1345–8.
- Chun R, Kirkpatrick AW, Sirois M, Sargasyn AE, Melton S, Hamilton DR, et al. Where's the tube? Evaluation of hand-held ultrasound in confirming endotracheal tube placement. Prehosp Disaster Med. 2004;19:366–9.
- Marciniak B, Fayoux P, Hébrard A, Krivosic-Horber R, Engelhardt T, Bissonnette B. Airway management in children: Ultrasonography assessment of tracheal intubation in real time? Anesth Analg. 2009;108:461–5.
- Lichtenstein D, Biderman P, Meziere G, Gepner A. Sinusogram, a real time ultrasound sign of maxillary sinusitis. Intensive Care Med. 1998;24:1057–61.
- Butcher C. Ultrasound evaluation of the neck and upper respiratory system. In: Levitov A, Mayo P, Slonim A, editors. Critical Care Ultrasonography. 1st ed. USA: McGraw.Hill; 2010. pp. 235–8.
- Friedman EM. Role of ultrasound in the assessment of vocal cord function in infants and children. Ann Otol Rhinol Laryngol. 1997;106:199–209.
Source: PubMed