Evaluation of skin to epiglottis distance, tongue thickness and hyomental distance by airway ultrasound for predicting difficult laryngoscopy: A prospective observational study.

The primary responsibility of the anesthesiologist is to provide adequate oxygenation and

ventilation to the patient by securing the airway. 1

An unanticipated situation of “Cannot Intubate Cannot Oxygenate” is most dreaded among

the anesthesiologists. These events mainly pertain to failure of maintaining patent airway.

To prevent such untoward events, many methods have been introduced to identify who can

be easily intubated or not. 2

Difficulty in airway management is a significant cause of morbidity and mortality in

anesthesia, intensive care, and emergency medicine practice. Recognizing patients at risk of

difficult tracheal intubation is essential, especially in patients with apparently normallooking

airways. Difficult laryngoscopy (DL) is considered a surrogate indicator of difficult

intubation. 3

However, every once in a while, an anesthesiologist encounters an unanticipated difficult

intubation, which leads to stressful clinical situations, especially in resourcepoor

highvolume centres. The incidence of DL ranges between 1.5 and 13%, and the primary

goal of the anesthesiologists is to recognize the difficult airway (DA) and to reduce or

eliminate potential risks linked to its precise management. 3

Ultrasound has also emerged as a promising tool for airway assessment and management

due to its familiarity, accessibility, safety, and non-invasive nature. It can assist physicians

in identifying relevant anatomy with objective measurements of airway parameters and

guiding airway interventions with dynamic real-time images. 4

This study aims to ultrasonographically assess the soft tissue thickness preoperatively based

on three parameters-skin to epiglottis distance, tongue thickness and hyomental distance and

find out whether these parameters can predict a difficult airway in adults.