Hsun-Hong Ignatius Wong, Izaham Azarinah, Masri Syarifah Noor Nazihah Sayed, Maaya Muhammad, Mahdi Siti Nidzwani Mohamad, Kader Khazrul Nizar Abd, Budiman Maryam, Yaacob Yazmin
Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia.
Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia.
Diagnostics (Basel). 2025 Jun 25;15(13):1615. doi: 10.3390/diagnostics15131615.
: Effective mask ventilation is a very important aspect of ensuring adequate oxygenation and ventilation. However, predicting difficult mask ventilation (DMV) using bedside clinical tests remains challenging due to poor sensitivity. Our objective was to determine the correlation between the preoperative ultrasonography of anterior neck anatomy and difficult mask ventilation in different obesity classes. : A prospective, observational study enrolled 90 adult obese patients undergoing general anesthesia from December 2020 to November 2021 (30 patients for each class of obesity). Ultrasonography measurements were recorded for the distance of skin (DS) to hyoid bone (DSHB), epiglottis (DSEM), the anterior commissure of the vocal cords (DSAC), thyroid isthmus (DSTI), and trachea at jugular notch (DSTJ). The difficulty of bag mask ventilation was graded using the Han scale. The Kendall Tau correlation coefficient was used to correlate the different ultrasonography parameters to DMV. Receiver-operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the measured ultrasonography distances, and the Youden index was used to calculate the optimal cut-off values. : Results revealed twenty patients (22.2%) were categorized as having difficult mask ventilation. There was a statistically significant increase ( = 0.011) in the number of patients with Mallampati II in class III obesity compared to class I obesity. DSHB showed a statistically significant and strong correlation with difficult mask ventilation in patients with class II ( = 0.002, r = 0.464) and class III obesity ( = 0.002, r = 0.475). A DSHB cut-off value of 1.35 cm has a sensitivity of 83.3% and specificity of 78.8% for class III obesity. Similarly, a DSTJ cut-off value of 1.13 cm has a sensitivity of 83.3% and specificity of 66.7% for class III obesity. : Notably, DSHB was the most specific parameter and equally as sensitive as DSTJ in predicting difficult mask ventilation in morbidly obese patients.
有效的面罩通气是确保充足氧合和通气的一个非常重要的方面。然而，由于敏感性较差，使用床边临床检查预测困难面罩通气（DMV）仍然具有挑战性。我们的目的是确定术前颈部前方解剖结构的超声检查与不同肥胖等级患者的困难面罩通气之间的相关性。
一项前瞻性观察性研究纳入了2020年12月至2021年11月期间接受全身麻醉的90名成年肥胖患者（每个肥胖等级30名患者）。记录了皮肤（DS）到舌骨（DSHB）、会厌（DSEM）、声带前联合（DSAC）、甲状腺峡部（DSTI）以及颈静脉切迹处气管（DSTJ）的超声测量距离。使用Han量表对面罩通气的困难程度进行分级。使用Kendall Tau相关系数将不同的超声参数与DMV进行关联。使用受试者操作特征（ROC）曲线来确定所测量的超声距离的敏感性和特异性，并使用约登指数来计算最佳截断值。
结果显示，20名患者（22.2%）被归类为面罩通气困难。与I级肥胖相比，III级肥胖患者中Mallampati II级患者的数量有统计学显著增加（P = 0.011）。DSHB在II级（P = 0.002，r = 0.464）和III级肥胖患者中与困难面罩通气显示出统计学显著且强烈的相关性（P = 0.002，r = 0.475）。对于III级肥胖，DSHB截断值为1.35 cm时，敏感性为83.3%，特异性为78.8%。同样，对于III级肥胖，DSTJ截断值为1.13 cm时，敏感性为83.3%，特异性为66.7%。
值得注意的是，在预测病态肥胖患者的困难面罩通气方面，DSHB是最具特异性的参数，并且与DSTJ一样敏感。
