Role of Ultrasonographic parameters in predicting difficult airway in patients with acute brain injury-A prospective observational study

Airway management comprises a critical component of anesthesia practice. Difficult airway may lead to a multitude of complications ranging from hypoxia, hypercarbia to cardiac arrest & death. Routine clinical airway assessment can successfully predict difficult airway in conscious cooperative patients. However acute brain injury patients pose a unique challenge in this regard as they do not cooperate for routine airway assessment due to altered mental status. Hence routine airway assessment in these patients may be insufficient & inadequate to predict difficult airway. Failing to identify difficult airway  may lead to airway complications leading to hypoxia or hypercarbia which might further increase the overall morbidity & mortality in these patients. Ultrasonography is a quick bed side tool which can be easily used to examine the airway anatomy in these patients. Various ultrasonographic parameters like tongue thickness, visibility of the hyoid bone, hyomental distance, anterior soft tissue thickness of the neck at the level of hyoid, thyrohyoid membrane & vocal cords have successfully predicted difficult airway with varying degrees of sensitivity & specificity. However, no literature is available on the validity & accuracy of these parameters in predicting difficult airway in brain injured patients.  Hence the primary purpose of the study is to determine the ultrasonographic parameters that predict difficult airway in patients with acute brain injury.