To determine the relationship between shapes of epiglottis and the incidence of difficult endotracheal intubation - A prospective observational study

As an anesthesiologist airway management is our biggest concern in unanticipated situations with difficult airways. Even though patients are assessed in the pre anesthetic clinic with clinical airway assessments and general physical examinations prior to the procedure, unanticipated difficult airways can occur on the table.

It is known that the Cormack and Lehane grading system is used to predict intubation difficulty. However the shape of the epiglottis affects the visible range of the vocal cords. Research has shown that the shape of the epiglottis can have a significant impact on airway difficulty during intubation. A normally shaped epiglottis is associated with easier intubation, while abnormally shaped epiglottis, like omega shaped or floppy, have an increased risk of difficult intubation.

Anesthesiologists should assess the shape of the epiglottis during laryngoscopy and consider alternative intubation techniques or assistive devices, such as bougies, video laryngoscopes, fiberoptic scopes, or calling upon expert senior personnel for difficult intubation. By understanding the relationship between the shape of the epiglottis and intubation difficulty, anesthesiologists can improve airway management in difficult situations and improve patient outcomes. By recognizing the problems associated with the shapes of the epiglottis, physicians can devise better airway management strategies to overcome difficulties and ensure patient safety through successful airway securement.

We have planned to conduct this study in operating rooms of our instituition going on all patients undergoing elective surgery and intubation with endotracheal tube on under general anaesthesia with endotracheal intubation

This prospective observational study aims to estimate the relationship between the shape of the epiglottis and the ease of endotracheal intubation, and to identify the implications of epiglottis shape on airway management. Patients will be recruited on the basis of inclusion and exclusion criteria, and informed consent will be obtained by the primary investigator.

With adequate fasting the patient will receive general anaesthesia using standard induction agents chosen by the anaesthesiologist in the operating room. The senior anaesthesiologist will perform the laryngoscopy with adequate relaxation and depth of anaesthesia using a standard mac 3 blade and an endotracheal tube without a stylet, and assess the shape of the epiglottis at laryngeal expansion. If unanticipated difficulty is encountered, any modification in the intubation techniques, such as the usage of a stylet, bougie, change of blade, or videolaryngoscopy, will be noted. The difficulty of intubation will be graded with Cormack Lehane laryngoscopy grading and the data will analysed