Altınsoy Kazım Ersin, Bayhan Bahar Uslu
Department of Emergency Medicine, Gaziantep Islam Science and Technology University, Gaziantep City Hospital, 27470 Gaziantep, Türkiye.
Department of Anesthesia and Reanimation, Gaziantep City Hospital, 27470 Gaziantep, Türkiye.
J Clin Med. 2025 Mar 19;14(6):2092. doi: 10.3390/jcm14062092.
: Difficult intubation is a significant clinical issue in emergency medicine as well as anesthesia practice, occurring more frequently in obese patients. Traditional assessment methods may not be sufficient to predict difficult intubation. This study aims to evaluate the ability of ultrasound-measured skin-to-epiglottis distance (SED) to predict difficult laryngoscopy in obese patients and investigate its applicability in clinical practice. : This prospective observational study was conducted between February 2024 and January 2025 at Gaziantep City Hospital on obese patients undergoing bariatric surgery. Patients aged 18 years and older with an American Society of Anesthesiologists (ASA) classification of I-II-III were included in the study. Demographic data, standard airway assessment parameters (neck circumference, thyromental distance, sternomental distance, etc.), and ultrasound-measured skin-to-epiglottis distance were recorded. All intubation procedures were performed by a single experienced anesthesiologist following standard protocols, and laryngoscope view was assessed according to the Cormack-Lehane classification. : Among the 61 patients included in the study, 16.4% were classified as having a difficult airway, and 13.1% experienced difficult intubation. No significant correlation was found between standard airway assessment parameters and difficult intubation. However, ultrasound-measured skin-to-epiglottis distance (SED) was significantly higher in patients with difficult intubation ( = 0.004), making it a strong predictor. Additionally, modified Mallampati ( < 0.001), modified Cormack-Lehane ( = 0.003), and Wilson scores ( = 0.001) were significant in predicting difficult airway, although Wilson score was not significant for difficult intubation ( = 0.099). : Our study suggests that ultrasound-measured skin-to-epiglottis distance may be a valuable predictor of difficult intubation in obese patients. Given the limitations of preoperative assessment methods, incorporating ultrasound into airway evaluation as a complementary tool provides significant benefits. Larger-scale studies in the future are necessary to further assess the clinical efficacy of this method.
困难气道插管是急诊医学和麻醉实践中的一个重要临床问题，在肥胖患者中更为常见。传统的评估方法可能不足以预测困难气道插管。本研究旨在评估超声测量的皮肤至会厌距离（SED）预测肥胖患者困难喉镜检查的能力，并探讨其在临床实践中的适用性。
本前瞻性观察性研究于2024年2月至2025年1月在加济安泰普市医院对接受减肥手术的肥胖患者进行。年龄在18岁及以上、美国麻醉医师协会（ASA）分级为I-II-III级的患者纳入研究。记录人口统计学数据、标准气道评估参数（颈围、甲状软骨至颏下距离、胸骨至颏下距离等）以及超声测量的皮肤至会厌距离。所有插管操作均由一名经验丰富的麻醉医师按照标准方案进行，并根据Cormack-Lehane分级评估喉镜视野。
在纳入研究的61例患者中，16.4%被归类为困难气道，13.1%经历了困难气道插管。标准气道评估参数与困难气道插管之间未发现显著相关性。然而，困难气道插管患者的超声测量皮肤至会厌距离（SED）显著更高（P = 0.004），使其成为一个强有力的预测指标。此外，改良Mallampati分级（P < 0.001）、改良Cormack-Lehane分级（P = 0.003）和Wilson评分（P = 0.001）在预测困难气道方面具有显著意义，尽管Wilson评分对困难气道插管不具有显著意义（P = 0.099）。
我们的研究表明，超声测量的皮肤至会厌距离可能是肥胖患者困难气道插管的一个有价值的预测指标。鉴于术前评估方法的局限性，将超声作为一种辅助工具纳入气道评估具有显著益处。未来有必要进行更大规模的研究以进一步评估该方法的临床疗效。
