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.

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