Ultrasound measurements of anterior soft tissue thickness to predict difficult laryngoscopy in women undergoing elective cesarean section under general anesthesia.

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Obstetric patient airway management is becoming important, because of anatomical and physiological changes in the airway related to the pregnancy. The aim of our study was to compare the ultrasound (USG) measurements of 5 different levels of anterior neck soft tissue and other clinical screening tests for determination of difficult laryngoscopy in patients who underwent cesarean section operation with general anesthesia.. Materials and Methods: Prospective, observational study included 140 pregnant women (18-45 years old, ASA I-II) who underwent elective cesarean section under general anesthesia. A written informed consent was obtained from each patient. The study protocol was approved by the local Ethics Committee. Patients with difficult airway anamnesis, history of neck surgery were not included in the study. In addition, very urgent cases such as acute fetal distress and ablatio placenta were excluded from the study. Mallampati test, mouth opening, sternomental distance, thyromental distance, upper lip bite test, neck circumference were recorded. The distance from the skin to the anterior aspect of the trachea was measured at five different levels: hyoid bone (zone 1), tirohyoidmembrane (zone 2), vocal cords (zone 3), thyroid isthmus (zone 4) and suprasternal notch (zone 5). An anaesthesiologist who were unaware of the clinical screening variables and USG results performed laryngoscopy. When second attempt for intubation was failed, to use of other difficult intubation equipments were planned. Results: 120 patients were evaluated statistically. According to Cormack and Lehane’s scale, patients were divided into two groups: a grade 1 or 2 was accepted easy laryngoscopy, whereas a grade 3 or 4 was considered difficult laryngoscopy. 30 patients were classified as having difficult laryngoscopy (25 %). All of the patients were entubated succesfully. Amoung the other clinical screening tests for difficult laryngoscopy: limited mouth opening (<3cm), high Wilson's Risk Score (> 2), large neck circumference (> 40 cm), unable to bite the upper lip, and high mallampati score (III-IV) were found higher in the difficult laryngoscopy group (p<0.05). Also, BURP maneuver, useage of gum elastic bougie, high intubation difficulty score (IDS =5), three more intubation attempts, airway difficulty rate were significantly higher in the difficult laryngoscopy group (p<0.05). Conclusion(s): We thought that USG measurement of anterior neck soft tissue has no influence on determination of difficult laryngoscopy in pregnant patients.

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