This is a study to evaluate the role of ultrasound assessment of airway before surgery to predict difficulty in mask ventilation under anesthesia

Active, not recruiting

Conditions: Medical and Surgical,

Registration Number: CTRI/2020/01/023050

Lead Sponsor: Maulana Azad Medical College

Brief Summary: Effective mask ventilation plays a critical role in safe management of airway before intubation or after failed intubation. Failure to provide adequate oxygenation resulting from difficult mask ventilation (DMV) can lead to life threatening complications in both elective and emergency settings. Thus, it is very important to identify patients at risk of DMV. Prediction of DMV based on clinical evaluation of anesthesiologist alone is not always accurate and may lead to unanticipated DMV. This necessitates the need for diagnostic tools which may be considered adjunct to the conventional pre-operative assessment in predicting DMV and can contribute to safer airway management.

During the last few years ultrasound has been used widely in the operating room for ultrasound guided procedures such as nerve block or central venous access. It has been suggested that pre-operative ultrasound measurement of airway when combined with commonly used screening tests and risk factor assessment for DMV might improve the ability to predict the difficulties.

Previous studies have found the anterior neck measurements using ultrasound to be associated with DMV, especially the distance from skin to hyoid bone (DSHB). Ultrasound measurement of tongue thickness to oral cavity height ratio (TT/OCH) has been observed to be consistent with CT findings of tongue volume to oropharyngeal volume ratio and tongue thickness to oral cavity height ratio.

Under general anesthesia, the tongue may obstruct the upper airway by pushing the soft palate against the posterior pharyngeal wall, obstructing both the nasal and oral cavities or the tongue may close the oral cavity when the nose is obstructed, then acting as a one-way valve obstructing expiration. Thickness of tongue relative to oral cavity height may predispose to upper airway obstruction and result in DMV. Thus, we thought it would be worthwhile to study the role of ultrasound measurement of tongue thickness to oral cavity height (TT/OCH) ratio in predicting DMV. So, we aim to evaluate the role of ultrasound guided TT/OCH ratio and anterior neck measurements in predicting DMV.

Detailed Description: Not available

Recruitment & Eligibility

Status: Closed to Recruitment of Participants

Sex: All

Target Recruitment: 102

Inclusion Criteria

Patients scheduled for surgery under general anesthesia requiring mask ventilation after 1 minute of administration of neuro-muscular blockade.
American Society Of Anesthesiologists Physical Grade I, II, III.

Exclusion Criteria

Patients in whom achieving a proper mask seal will be difficult including but not limited to edentulous, beard, scars, swellings, dressings over the face.
Patients requiring awake intubation.
Patients requiring rapid sequence intubation.
Pregnant woman.

Study & Design

Study Type: Observational

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Association between ultrasound measurement of tongue thickness to oral cavity height (TT/OCH) ratio and difficult mask ventilation (DMV).	During mask ventilation after 1 minute of administration of muscle relaxant.

Secondary Outcome Measures

Name	Time	Method
1. Association between anterior neck measurements by ultrasound and difficult mask ventilation (DMV).	2. Association between tongue thickness by ultrasound to thyromental distance ratio and DMV.

Trial Locations

Locations (1): Maulana Azad Medical College
🇮🇳
Delhi, DELHI, India
Maulana Azad Medical College
🇮🇳Delhi, DELHI, India
Vishrantkumar K Kushal Shetty
Principal investigator
9110841070
vishranth8@gmail.com