Turkish Journal of Medical Sciences




Difficult mask ventilation and difficult intubation are more common in obese patients. Ultrasound is a reliable andnoninvasive method for evaluating the airway. The aim of this study was to investigate the contribution and availability of anterior necksoft tissue (ANS) thickness at different levels, tongue volume (TV), hyomental distance (HMD), the ratio of preepiglottic distance todistance between the epiglottis and the midpoint of vocal cords (PE/E-VC) measured by ultrasonography in predicting difficult airwayin morbidly obese patients.Materials and methods: Between March 2020 and November 2020, patients aged ≥18 years with a body mass index (BMI) of ≥40 kg/m2who underwent elective surgery under general anesthesia were included in this prospective study at Fırat University Hospital. Duringthe preoperative evaluation of patients, ultrasound was used to measure and record TV, ANS thickness at different levels, HMD, andratio of PE/E-VC. Patients with difficult intubation were identified using the Cormack-Lehane classification system. Patients whohaddifficulties with balloon mask ventilation were recorded. Subsequently, the parameters of patients with easy and difficult intubation werecompared. In addition, the parameters of patients with easy and difficult mask ventilation were also compared.Results: The preepiglotticANS thickness at the level of the thyrohyoid membrane and the PE/E-VC value in obese patients with difficult intubation weresignificantly greater than in obese patients with easy intubation (p < 0.001). In addition, TV (p < 0.001), preepiglottic ANS thickness atthe thyrohyoid membrane level (p < 0.001), ANS thickness at the thyroid isthmus level (p = 0.002), ANS-suprasternal notch thickness(p = 0.004), and PE/E-VC (p = 0.005) values were significantly greater in obese patients with difficult mask ventilation.Conclusion: Ultrasound may be a useful tool for predicting difficult airway and difficult mask ventilation. For this purpose, ANSthickness at different levels, PE/E-VC, and TV values measured by ultrasound can be used.


Obesity, difficult airway, ultrasound, intubation, neck

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