Ganjoo Shivangi, Dhamija Ekta, Garg Rakesh, Bhatnagar Sushma, Mishra Seema, Bharati Sachidanand Jee, Gupta Nishkarsh, Kumar Vinod
Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, AIIMS, New Delhi, India.
Department of Radiology, Dr BRAIRCH, AIIMS, New Delhi, India.
Indian J Anaesth. 2025 Sep;69(9):899-908. doi: 10.4103/ija.ija_485_25. Epub 2025 Aug 12.
Traditional airway assessment methods likely miss findings, resulting in unanticipated difficult airways. Surgeons routinely do computed tomography (CT) scans of head and neck cancer patients to determine the extent and resectability of the disease. We used these images for 3-dimensional CT (3D CT) reconstruction to provide additional airway-related information to the anaesthesiologist and studied its impact on airway management.
We randomly allocated 60 patients into two groups to formulate the airway management plan: Group A (Conventional airway assessment) and Group B (Conventional airway assessment along with 3D CT findings). A CT reporting format was prepared based on a literature review after discussion with radiologists and airway experts. In the case of luminal obstruction, a virtual endoscopy video was also created. These findings were shown to the anaesthesiologist managing the airway, and any change in the primary plan was noted. The primary outcome was the total time required for successful airway management. Secondary outcomes included the number of attempts, number of alternative techniques, other manoeuvres required, incidence of failed intubation, and any complications. Data were analysed using the SPSS statistics software.
The airway management time between both groups was comparable, with a median difference of 0 [95% confidence interval (CI): -14, 20; = 0.752]. Among the manoeuvres used, optimal external laryngeal manipulation (OELM) was required more in Group A ( = 0.007). Both groups had no difference in the number of attempts ( > 0.99), number of alternative techniques ( = 0.052), and complications ( > 0.99). There was a significant change in the endotracheal tube size after CT findings were shown ( < 0.001). It aided in selecting the preferred side of the nostril for nasotracheal intubation (kappa = 0.545, showing moderate agreement between before and after CT groups). As per the feedback from anaesthesiologists who rated 3D CT on a Likert scale, it was considered beneficial for airway assessment.
3D CT reconstruction and virtual endoscopy can be a valuable method of airway assessment.
传统气道评估方法可能会遗漏一些发现，从而导致意外的困难气道情况。外科医生通常会对头颈部癌症患者进行计算机断层扫描（CT），以确定疾病的范围和可切除性。我们利用这些图像进行三维CT（3D CT）重建，为麻醉医生提供额外的气道相关信息，并研究其对气道管理的影响。
我们将60例患者随机分为两组以制定气道管理计划：A组（传统气道评估）和B组（传统气道评估结合3D CT检查结果）。在与放射科医生和气道专家讨论后，基于文献综述制定了CT报告格式。对于管腔阻塞的情况，还制作了虚拟内镜视频。这些检查结果展示给负责气道管理的麻醉医生，并记录主要计划的任何变化。主要结局指标是成功进行气道管理所需的总时间。次要结局指标包括尝试次数、替代技术的数量、所需的其他操作、插管失败的发生率以及任何并发症。使用SPSS统计软件对数据进行分析。
两组之间的气道管理时间相当，中位数差异为0 [95%置信区间（CI）：-14, 20；P = 0.752]。在所采用的操作中，A组需要更多地进行最佳外部喉操作（OELM）（P = 0.007）。两组在尝试次数（P > 0.99）、替代技术的数量（P = 0.052）和并发症（P > 0.99）方面没有差异。在展示CT检查结果后，气管导管尺寸有显著变化（P < 0.001）。它有助于选择鼻气管插管时更合适的鼻孔侧（kappa = 0.545，显示CT检查前后两组之间有中度一致性）。根据以李克特量表对3D CT进行评分的麻醉医生的反馈，其被认为对气道评估有益。
3D CT重建和虚拟内镜可以成为一种有价值的气道评估方法。
