Preoperative Airway Ultrasound Combined with Clinical Assessment Improves Prediction of Difficult Laryngoscopy: A Prospective Observational Study

December 10, 2025/45 Comments/in Volume 6; Issue 2: July-December 2025/by Ijraijraadmin

Vol 6 | Issue 2 | July-December 2025 | Page 07-10 | Himaunshu Dongre, Sandeep Diwan, Bharti Adhye, Suhrud Panchwagh, Parag Sancheti

DOI: https://doi.org/10.13107/ijra.2025.v06.i02.130

Open Access License: CC BY-NC 4.0

Submitted: 21-10-2025; Reviewed: 17-11-2025; Accepted: 29-11-2025; Published: 10-12-2025

Authors: Himaunshu Dongre [1], Sandeep Diwan [1], Bharti Adhye [1], Suhrud Panchwagh [2], Parag Sancheti [3]

[1] Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India.
[2] MBBS, Smt. Kashibai Navale Medical College, Pune, Maharashtra, India.
[3] Department of Orthopaedics, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence

Dr. Himaunshu Dongre,
Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India.
E-mail: himaunshu.dongre@gmail.com

Abstract

Background: Conventional bedside airway assessment tests have limited accuracy in predicting difficult laryngoscopy. Point-of-care airway ultrasound provides objective anatomical information and may improve preoperative airway evaluation. This study evaluated the role of ultrasonographic airway measurements alone and in combination with conventional clinical assessment in predicting difficult laryngoscopy.
Methods: In this prospective observational study, 40 adult patients undergoing elective lumbar spine surgery under general anaesthesia underwent preoperative airway evaluation using Modified Mallampati classification, sternomental distance, mentothyroid distance, and mentohyoid distance. Airway ultrasound was performed using a high-frequency linear probe to measure skin-to-epiglottis distance (SED) and skin-to-midpoint of the vocal cords distance (SVD). Direct laryngoscopy was performed by an anaesthesiologist blinded to the airway assessment findings, and laryngoscopic view was graded using the Cormack-Lehane classification. Logistic regression and receiver operating characteristic (ROC) analyses were used to determine predictive performance.
Results: Thirteen patients (32.5%) had difficult laryngoscopy. Among the ultrasonographic parameters, SED was the strongest independent predictor of difficult laryngoscopy (p=0.035). Ultrasound-based assessment demonstrated higher diagnostic accuracy than conventional clinical tests alone. The combined clinical-ultrasound model achieved the best performance with a sensitivity of 92.3%, specificity of 96.2%, positive predictive value of 85.7%, and negative predictive value of 96.2%.
Conclusion: Airway ultrasound complements conventional bedside assessment and improves prediction of difficult laryngoscopy. Incorporation of SED into routine preoperative airway evaluation may facilitate better airway planning and enhance patient safety.
Keywords: Airway ultrasound, Difficult airway, Difficult laryngoscopy, Skin-to-epiglottis distance, Preoperative airway assessment.

References

1. Wang L, Feng YK, Hong L, Xie WL, Chen SQ, Yin P, et al. Ultrasound for diagnosing new difficult laryngoscopy indicator: a prospective, self-controlled, assessor-blinded observational study. Chin Med J (Engl). 2019;132:2066-72.
2. Lee A, Fan LT, Gin T, Karmakar MK, Ngan Kee WD. A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg. 2006;102:1867-78.
3. Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115:827-48.
4. Osman A, Sum KM. Role of upper airway ultrasound in airway management. J Intensive Care. 2016;4:52.
5. Parameswari A, Govind M, Vakamudi M. Correlation between preoperative ultrasonographic airway assessment and laryngoscopic view in adult patients: a prospective study. J Anaesthesiol Clin Pharmacol. 2017;33:353-8.
6. Hui CM, Tsui BC. Sublingual ultrasound as an assessment method for predicting difficult intubation: a pilot study. Anaesthesia. 2014;69:314-9.
7. Sotoodehnia M, Rafiemanesh H, Mirfazaelian H, Safaie A, Baratloo A. Ultrasonography indicators for predicting difficult intubation: a systematic review and meta-analysis. BMC Emerg Med. 2021;21:76.
8. Martínez-García A, Guerrero-Orriach JL, Pino-Gálvez MA. Ultrasonography for predicting difficult laryngoscopy: getting closer. J Clin Monit Comput. 2021;35:269-77.
9. Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits AM, Arrich J, et al. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst Rev. 2018;5:CD008874.

How to Cite this Article: Dongre H, Diwan S, Adhye B, Panchwagh S, Sancheti P. Preoperative Ultrasound Imaging of the Airway: A New Tool in Anticipating Difficult Airway in Clinical Practice. International Journal of Regional Anaesthesia. July-December 2025; 6(2): 07-10. DOI: https://doi.org/10.13107/ijra.2025.v06.i02.130