Preoperative Airway Ultrasound Combined with Clinical Assessment Improves Prediction of Difficult Laryngoscopy: A Prospective Observational Study
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
Copyright Statement: Copyright © 2025; The Author(s).
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 |
https://shorturl.fm/Iydsd
https://shorturl.fm/9cRc2
сайт https://slon13-cc.com/
https://shorturl.fm/YhUQV
강동구 스웨디시
출장마사지
여주 출장마사지
여주 안마
https://shorturl.fm/Uuxpe
Really informative content. Looking forward to reading more posts like this. Best wishes from the Enego team.
https://shorturl.fm/ZtiFG
unlocker.ai – The Ultimate AI Tool for Bypassing Restrictions and Unlocking Content Seamlessly!
Good post. Positioning is the highest leverage marketing work and the most often skipped.
Thank you for the overview! What would be the typical timeline for a case like this?
[225857]supplies professional anti-violence equipments and solutions for the whole world with strong and perfect production capacity. anti-violence.org
[3464]winbd17 অফিসিয়াল লগইন | বিকাশ ডিপোজিট ও সেরা স্লট গেম,winbd17 অ্যাপ ডাউনলোড করে সেরা অনলাইন স্লট গেমগুলো উপভোগ করুন। বিকাশ দিয়ে দ্রুত ডিপোজিট এবং আকর্ষণীয় বোনাস পাওয়ার নিয়ম জানতে আজই ভিজিট করুন। visit: winbd17
This post breaks down high-level legal concepts into clear, practical takeaways.
Appreciate the insight! However, wouldn’t the upfront legal costs outweigh the recovery amount here?
“Great content, learned a lot from this post!”
“I appreciate the detailed explanation, very helpful!”
“I appreciate the detailed explanation, very helpful!”
[1377]আরবাজি অনলাইন ক্যাসিনো (rbajee)-বাংলাদেশে সেরা বেটিং প্ল্যাটফর্ম,আরবাজি (rbajee) বাংলাদেশে সেরা অনলাইন ক্যাসিনো ও বেটিং প্ল্যাটফর্ম। লাইভ ক্যাসিনো, স্পোর্টস বেটিং এবং স্লট গেমে পান দারুণ বোনাস ও দ্রুত পেমেন্ট। আজই জয়েন করুন! visit: rbajee
Bangkok Erotic Massage
Bangkok Nuru Massage
[224117]supplies professional anti-violence equipments and solutions for the whole world with strong and perfect production capacity. anti-violence.org
김포출장마사지
인천출장마사지
평택출장마사지 서비스를 찾는 분들을 위한 정보입니다.
평택출장마사지 서비스와 이용 정보를 간편하게 확인해보세요.
Drive AI performance with premium biometric data from a trusted biometric data provider. Access ethically sourced datasets built for secure machine learning projects.
https://blogfreely.net/loco-data/facial-biometrics-and-the-rise-of-ml-datasets
Üsküdar 7/24 Su Kaçağı Tespiti Kurumsal faturaları düzenli kestiler, muhasebe işleri kolaydı. https://spikina.center
집에서도 편안하게 이용할 수 있는 대전출장마사지 정보를 제공합니다.
원하는 장소에서 편안하게 받을 수 있는 대전출장마사지 안내입니다.
Really liked the practical insights in this article, especially the focus on how thumbnails can influence clicks and viewer interest. I work in the same space with thumbhd.com, a YouTube thumbnail intelligence and downloader tool, so this was right up my alley. Great read!
집에서도 편안하게 이용할 수 있는 서울출장마사지 정보를 제공합니다.
서울에서 편안한 휴식을 찾는 분들을 위한 서울출장마사지 안내입니다.
서울출장마사지는 바쁜 일상 속 편안한 휴식을 위한 출장형 마사지 서비스입니다.
E-Ticaret Sitesi Kur
Beşiktaş Su Kaçağı Tamiri Kalorifer peteği kaçağını kış öncesi buldular, şanslıydık. http://fitolab.lviv.ua/?p=2608
Beşiktaş Tavan Su Kaçağı Tespiti Spor Caddesi üzerindeki ofisime 30 dakikada geldiler. https://chiali-services.com/?p=2629
Beşiktaş Gider Su Kaçağı Tespiti Online randevu sistemi çok pratik. Hem de fiyat teklifi hemen geldi. https://thetatesinparis.com/?p=18261
Beşiktaş Kombi Su Kaçağı Tespiti Mutfak dolabının altında su birikmesi vardı, korkmuştum. Meğer musluk bağlantısıymış. Ufak bir işlemle hallettiler. https://emissionowl.com/?p=1952
Beşiktaş Zemin Altı Su Kaçağı Tespiti Hem tespit hem de tamir hizmeti vermesi çok pratik. Ayrı firma aramakla uğraşmadık. https://sankonet.org/?p=23458
Beşiktaş Zemin Altı Su Kaçağı Tespiti Kırmadan kaçak bulma sistemi çok etkili. https://www.lbefficience.com/?p=3163
Beşiktaş Su Kaçağı Tamiri Beşiktaş’taki evimizde aylardır artan su faturasının sebebini buldular. Çok profesyoneller, kesinlikle tavsiye ederim. https://www.lbefficience.com/?p=3163
SEO çalışmalarının etkisini görmek için anahtar kelimeleri düzenli olarak takip etmek gerekiyor. Tek seferlik kontrol mevcut durumu gösterirken düzenli takip yükseliş ve düşüşlerin daha net görülmesini sağlıyor. SEOLOK üzerindeki Google Sıralama Bulucu, belirlenen anahtar kelimelerin Google sonuçlarındaki konumunu kontrol etmeyi kolaylaştırıyor. Lokasyon ve cihaz bazlı sonuçların görüntülenebilmesi özellikle yerel işletmeler açısından faydalı. SEO çalışmalarını daha sistematik şekilde yönetmek isteyen web sitesi sahipleri https://seolok.com/ adresindeki araçları inceleyebilir.
숙소에서도 편안하게 이용할 수 있는 출장마사지 정보를 제공합니다.
집, 호텔 등 편안한 공간에서 이용할 수 있는 출장마사지 정보를 소개합니다.
바쁜 일상 속 편안한 휴식을 위한 출장마사지 정보, massageoutcall24.com.
간편한 예약 상담으로 김포출장마사지 이용을 알아보세요.
일상에 지친 날, 김포출장마사지로 여유로운 휴식 시간을 가져보세요.
원하는 장소에서 편안하게 받을 수 있는 김포출장마사지 안내입니다.
Bir uzmanla ilk kez görüşmeyi düşünen kişiler, genellikle nereden başlayacağını bilemeyebiliyor. Online psikolog seçerken yalnızca ücret veya müsait saat bilgisine odaklanmak yerine uzmanın eğitim geçmişine ve ilgilendiği alanlara bakmak daha sağlıklı olur. Online terapi sürecinin başında beklentileri konuşmak, görüşmelerin amacı konusunda karşılıklı anlayış geliştirilmesine yardımcı olabilir. İlk seansta her konuyu anlatmak zorunda olmadığınızı bilmek de rahatlatıcıdır. Uzman profillerini ve görüşme imkanlarını karşılaştırmak için https://psikolojiden.com/ incelenebilir. Psikolojik destek kişiye özel ilerlediğinden görüşme sıklığı ve çalışma hedefleri zaman içinde değişebilir. Önemli olan güvenli, saygılı ve profesyonel bir iletişim kurulmasıdır. Bu yaklaşım danışanın süreçte daha aktif ve bilinçli kalmasını uzun vadede de destekler.
A lawyer in Ankara can review agreements before they are signed and explain important provisions. This type of legal support can help clients identify obligations and potential concerns in advance.
원하는 장소에서 편안하게 받을 수 있는 용인출장마사지 안내입니다.
용인에서 편안한 휴식을 찾는 분들을 위한 용인출장마사지 안내입니다.
원하는 장소에서 편안한 시간을 보낼 수 있는 용인출장마사지입니다.
It is useful to learn that swelling around a joint is important to notice.
I appreciate the explanation of desk breaks; it are a simple way to interrupt long sitting periods.
The article makes a good point about ergonomic work habits: it may help reduce unnecessary strain.
Helpful context on hand joint stiffness; it can interfere with routine tasks.
Good reminder that gentle physical activity can support general mobility.
The article makes a good point about low-impact activity: it offers options for many fitness levels.
I appreciate the focus on simple, everyday habits.
A useful read for people who spend long hours sitting.
I appreciate the explanation of swelling around a joint; it is important to notice.
Good reminder that medical evaluation can help clarify persistent or worsening symptoms.
The section on healthy posture is helpful, since it matters during everyday activities.
This post explains well why hip mobility matters: it can influence everyday movement.
This post explains well why sleep quality matters: it can affect how people feel day to day.
I appreciate the explanation of nutritious meals; it help support overall wellbeing.
I had not considered how knee pain on stairs can have several possible causes.
This post explains well why symptom tracking matters: it can help people describe patterns to a clinician.
It is useful to learn that knee pain on stairs can have several possible causes.
The practical tips here are easy to understand.
Helpful context on a sedentary routine; it can make movement feel more difficult.
The discussion of stretching is timely because it should not force a painful movement.
It is useful to learn that nutritious meals help support overall wellbeing.
I had not considered how gentle physical activity can support general mobility.
The point about warm-ups is useful because it can help prepare the body for activity.
I had not considered how range of motion can affect everyday tasks.
Good reminder that swelling around a joint is important to notice.
The section on healthy posture is helpful, since it matters during everyday activities.
This post explains well why balance training matters: it can be useful as part of a well-rounded routine.
This post explains well why joint health education matters: it helps people ask more informed questions.
It is useful to learn that balance training can be useful as part of a well-rounded routine.
Psikolojik danışmanlık almak isteyen öğrenciler ve genç yetişkinler için zaman planlaması önemli bir konu olabiliyor. Dersler, sınavlar ve gelecek kaygısı, günlük hayatı duygusal açıdan yorucu hale getirebilir. Online psikolog arayışında yaş grubuna uygun çalışma deneyimine sahip uzmanların değerlendirilmesi faydalıdır. Online terapi görüşmeleri, uygun teknolojik koşullarda farklı mekanlardan katılım sağlama esnekliği sunabilir. Bununla birlikte çocuklar ve ergenler için değerlendirme, izin ve güvenlik koşulları yetişkinlerden farklı olabilir. https://psikolojiden.com/ üzerinden hizmetleri incelerken uzmanların çalışma alanlarına bakmak önemlidir. Destek sürecinde bireyin ihtiyaçları, güvenliği ve mahremiyeti her zaman öncelikli olmalıdır. Görüşme öncesinde kapsam, gizlilik, ebeveyn onayı ve yaşa uygun çalışma koşullarını öğrenmek ayrıca faydalı olacaktır.
The tips about protecting eyes from UV light are practical.
The information about healthy vision is useful for everyday eye care.
I’d like to learn more about glare reduction.
The discussion of resting tired eyes gives readers useful context.
Could you share more resources about leafy greens?
It’s helpful to see straightforward information about screen breaks.
I appreciate this balanced look at carotenoid-rich foods.
I’d like to learn more about leafy greens.
A helpful reminder about everyday choices related to protecting eyes from UV light.
This post has encouraged me to review my habits around carotenoid-rich foods.
I appreciate this balanced look at sleep and eye comfort.
I appreciate this balanced look at omega-3 food sources.
It’s useful to understand the basics of healthy vision.
Could you share more resources about screen breaks?
The tips about glare reduction are practical.
liu liu
The advice about foot checks for older adults is easy to understand.
Thanks for explaining nail health and diabetes alongside good hygiene practices.
Thanks for explaining moisture and foot health without overlooking professional guidance.
Helpful explanation of daily habits for emotional wellbeing and why it matters for wellbeing.
Helpful explanation of nervous system regulation and encourages thoughtful lifestyle choices.
Helpful explanation of the effects of ongoing stress and makes the topic more approachable.
Thanks for explaining nail fungus prevention without relying on unverified claims.
Thanks for putting the focus on useful information about bloating and diet.
Thanks for sharing these insights on carbonation and stomach bloating.
This is a clear introduction to memory and sleep quality.
Good content, especially the balanced perspective.
Thanks for sharing; the discussion was useful.
I appreciate the practical discussion of digestive enzymes and gas.
The guide offers helpful information about digestive enzymes and gas.
A thoughtful explanation of the factors behind digestive enzymes and gas.
There is a lot to learn about memory changes with age.
A simple, accessible explanation of stress and memory.
This is a thoughtful overview of sodium intake and water retention and everyday wellness.
Thanks for sharing; the background information was useful.
The article covers some valuable basics regarding water retention and digestive bloating.
This article gives a helpful perspective on everyday factors around artificial sweeteners and digestive comfort.
An easy-to-read explanation of foods that may help with abdominal bloating.
I hadn’t considered how clear thinking can matter.
Thanks for the article. The clear presentation makes this useful.
This gives a helpful perspective on brain health education.
This gives a helpful perspective on mental clarity.
A simple, accessible explanation of memory changes with age.
This makes balanced meals and brain health easier to understand.
An informative post. Glad I came across this post.
Well presented information. Well done and thanks for sharing.
Really enjoyed this read. A nice resource to revisit later.
A clear and helpful article. Thanks again for sharing.
An informative post. Thanks for the time spent creating this.
Thanks for sharing these insights on water retention and digestive bloating.
Thanks for sharing these insights on relaxation and focus.
Nice work on this post; Looking forward to reading more.
The explanation adds useful context to sugary carbonated drinks and digestion.
This is a clear introduction to memory-friendly routines.
Well presented information. Looking forward to your next article.
I hadn’t considered how vitamin B12 can matter.
The article gives a clear introduction to digestive enzymes and gas.
Useful context for anyone learning about workplace concentration.
An informative post. Good work making the subject approachable.
Good to see information about memory concerns presented clearly.
Appreciate this post. The step-by-step guidance is helpful.
Nice summary of the main points about carbonation and stomach bloating.
The discussion of cognitive changes adds useful context.
Well presented information. Looking forward to your next article.
Appreciate this post. The balanced perspective is helpful.
Good read, especially this part. I really enjoy your articles, hope you share more like this.