Cangiani Luis Henrique, Alves Rodrigo Leal, Mizubuti Glenio B, Moreira E Lima Rodrigo, Navarro E Lima Lais Helena
Clínica Campinense de Anestesiologia, Fundação Centro Médico Campinas, Campinas, SP, Brazil.
Hospital São Rafael, Salvador, BA, Brazil; Universidade Estadual Paulista (UNESP), Departamento de Anestesiologia e Especialidades Cirúrgicas, Botucatu, SP, Brazil.
Braz J Anesthesiol. 2025 Jul-Aug;75(4):844637. doi: 10.1016/j.bjane.2025.844637. Epub 2025 May 9.
Ultrasound (US) allows for rapid bedside airway assessment. We aimed to evaluate the US-measured cutaneous-epiglottic distance (CED) in predicting difficult laryngoscopy (Cormack-Lehane grades 3‒4). We also evaluated the potential association between CED, sex, patient's body mass index (BMI), and the independent associations between CED and increased odds for Cormack-Lehane grades 3‒4 (secondary outcomes).
Patients aged 18‒70 years scheduled for elective surgeries under general anesthesia with tracheal intubation were included. Those with a BMI > 35 kg.m and/or previous history of difficult intubation were excluded. CED was measured with patients anesthetized before tracheal intubation. Age, sex, BMI, type of surgery, and number of attempts until successful tracheal intubation were recorded. Receiver operator characteristic (ROC) curve analysis was performed to evaluate CED's clinical relevance. Secondary analyses compared the association between CED and BMI in patients with Cormack-Lehane grades 1‒2 versus those with grades 3‒4. The relationship between CED and BMI was assessed using multiple linear regression. Binary logistic regression was employed for predicting Cormack-Lehane grades 3‒4 as a dichotomous outcome with CED and BMI as a covariate.
ROC curve analysis revealed an area under the curve of 0.899 (p < 0.001). The maximum CED cut-off point (by Youden index) was 25.6 mm. CED and BMI were positively correlated, and both were independently associated with an increased odds for difficult laryngoscopy [odds ratio for CED = 1.81, 95% confidence interval (CI) 1.35‒2.41; BMI = 1.30, 95% CI 1.05‒1.59].
US-measured CED has a high discriminatory capability for predicting lower (1‒2) and higher (3‒4) Cormack-Lehane grades during direct laryngoscopy. CED was positively correlated with BMI and was independently associated with higher odds for difficult laryngoscopy.
超声（US）可用于床边快速气道评估。我们旨在评估超声测量的皮肤至会厌距离（CED）对预测困难喉镜检查（Cormack-Lehane分级3-4级）的价值。我们还评估了CED、性别、患者体重指数（BMI）之间的潜在关联，以及CED与Cormack-Lehane分级3-4级增加几率之间的独立关联（次要结局）。
纳入计划在全身麻醉下行气管插管择期手术的18-70岁患者。排除BMI>35kg/m²和/或有困难插管既往史的患者。在气管插管前对麻醉状态下的患者测量CED。记录年龄、性别、BMI、手术类型以及直至成功气管插管的尝试次数。进行受试者操作特征（ROC）曲线分析以评估CED的临床相关性。次要分析比较了Cormack-Lehane分级1-2级患者与3-4级患者中CED与BMI的关联。使用多元线性回归评估CED与BMI之间的关系。采用二元逻辑回归以CED和BMI作为协变量预测Cormack-Lehane分级3-4级这一二分结局。
ROC曲线分析显示曲线下面积为0.899（p<0.001）。最大CED截断点（由约登指数确定）为25.6mm。CED与BMI呈正相关，且二者均与困难喉镜检查几率增加独立相关[CED的比值比=1.81，95%置信区间（CI）1.35-2.41；BMI=1.30，95%CI 1.05-1.59]。
超声测量的CED在预测直接喉镜检查时较低（1-2）和较高（3-4）Cormack-Lehane分级方面具有较高的辨别能力。CED与BMI呈正相关，且与困难喉镜检查的较高几率独立相关。
