Fernandez-Vaquero Miguel Angel, Charco-Mora Pedro, Garcia-Aroca Miguel Angel, Greif Robert
Clinica Universidad de Navarra, Department of Anesthesiology and Critical Care, Madrid, Spain; Learning, Teaching, and Investigation Difficult Airway Group (FIDIVA).
Hospital Universitario y Politecnico La Fe de Valencia, Department of Anesthesiology and Critical Care, Valencia, Spain; Learning, Teaching, and Investigation Difficult Airway Group (FIDIVA).
Braz J Anesthesiol. 2023 Sep-Oct;73(5):539-547. doi: 10.1016/j.bjane.2022.07.003. Epub 2022 Jul 30.
Clinical airway screening tests intend to predict difficult airways, but none have a high predictive value. Recent systematic reviews correlate ultrasound with difficult laryngoscopy. This study aimed primarily to correlate ultrasound measurements of anatomical upper airway structures in the sniffing position with difficult direct laryngoscopy. The secondary aim was to observe gender-based differences.
This prospective, cross-sectional, single-center observational study included 209 patients requiring general anesthesia for elective surgery. Preoperatively, we performed six clinical airway assessments and three ultrasound measurements, which were the Distance from Skin to the Hyoid Bone (DSHB), to the Epiglottis (DSE), and to the anterior commissure of the vocal cords (DSAC) in a sniffing position. Benumof's criteria for the "best view at the first attempt" for direct laryngoscopy assessed the difficulty of laryngoscopy.
The distance from skin to the epiglottis was the best predictor of direct difficult laryngoscopy (defined as Cormack-Lehane grade ≥ 2b) with a minimum thickness cut-off at 2.70 ± 0.19 cm (sensitivity 91.3%; specificity 96.9%). The skin to the hyoid bone distance cut-off was 1.41 ± 0.30 cm with moderate correlation (sensitivity 80.4%; specificity 60.1%). No correlation was found for the distance to the anterior commissure of the vocal cords. In women compared to men, the skin to the epiglottis distance was more sensitive (92.3% vs. 90.9%) and specific (98.8% vs. 95.2%).
DSE in the sniffing position is the most reliable parameter for preoperative airway ultrasound assessment in the Caucasian population, with higher sensitivity and specificity in women, and might be considered as an independent predictor for direct difficult laryngoscopy.
临床气道筛查试验旨在预测困难气道，但尚无具有高预测价值的试验。最近的系统评价将超声与困难喉镜检查相关联。本研究主要目的是将嗅物位时解剖学上气道结构的超声测量值与困难直接喉镜检查相关联。次要目的是观察性别差异。
这项前瞻性、横断面、单中心观察性研究纳入了209例因择期手术需要全身麻醉的患者。术前，我们进行了六项临床气道评估和三项超声测量，即嗅物位时从皮肤到舌骨（DSHB）、会厌（DSE）和声门前连合（DSAC）的距离。采用贝努莫夫关于直接喉镜检查“首次尝试最佳视野”的标准评估喉镜检查的难度。
从皮肤到会厌的距离是直接困难喉镜检查（定义为Cormack-Lehane分级≥2b）的最佳预测指标，最小厚度截断值为2.70±0.19 cm（敏感性91.3%；特异性96.9%）。从皮肤到舌骨的距离截断值为1.41±0.30 cm，相关性中等（敏感性80.4%；特异性60.1%）。未发现与声门前连合距离的相关性。与男性相比，女性从皮肤到会厌的距离更敏感（92.3%对90.9%）和更具特异性（98.8%对95.2%）。
嗅物位时的DSE是白种人群术前气道超声评估最可靠的参数，在女性中具有更高的敏感性和特异性，可被视为直接困难喉镜检查的独立预测指标。
