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
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| 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 |
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The information is presented in a reader-friendly way. It is helpful to separate established information from claims that need more research. This was worth my time to read.
This gives me some useful points to look into further. The practical details make the topic easier to think about. Appreciate the time taken to explain the topic.
I like how clearly the subject is presented. Understanding the basics can help people make better-informed decisions. I found this discussion worthwhile.
I enjoyed the straightforward approach here. It is sensible to compare information from reliable sources. Good work keeping the discussion approachable.
I like how the topic is explained. The reminder to look at the bigger picture is especially valuable. I hope to see more practical content in the future.
Thanks for putting together this guide. The explanations make this topic feel less overwhelming. I found this discussion worthwhile.
Thanks for sharing this information. It is always worth checking trustworthy sources before acting on health information. I may explore some of the other articles on this site.
I like how clearly the subject is presented. It is useful to distinguish established evidence from claims that need more study. This gives me a helpful direction for further reading.
This is a thoughtful explanation of the topic. The practical details make the subject easier to understand. Please continue publishing clear guides on health topics.
This article gives readers helpful context. The explanations make this topic feel less overwhelming. This gives me a helpful direction for further reading.
This was an easy read. It is good to see attention given to both potential benefits and limitations. I found this discussion worthwhile.
This post gives readers a good starting point. This encourages me to do a little more reading on the subject. This has given me a few things to consider.
Thanks for sharing this information. It is good to see the importance of context included in the discussion. I look forward to reading more articles like this.
A thoughtful post with plenty to consider. I especially value the reminder to look at evidence and individual needs. I will be checking out more of the information on this site.
The topic is explained in a straightforward way. The article highlights why informed choices matter. This is a good starting point for anyone learning about the topic.
This post offers a good starting point. The clear structure makes it easier to follow the main ideas. I found this discussion worthwhile.
Thanks for putting together this guide. Clear explanations help readers separate useful information from common assumptions. I found this discussion worthwhile.
Thanks for sharing this explanation. It is always worth checking sources and understanding the available evidence. Looking forward to reading more articles like this.
A useful resource for anyone researching this subject. It is good to see the importance of context included in the discussion. This was time well spent.
This gives readers a good starting point. I found the emphasis on making informed decisions particularly useful. The clear writing makes a difference.
This is a useful overview of an important subject. A balanced perspective is important when researching health products. Good work keeping the discussion approachable.
I found this post easy to follow. It is helpful to understand the basics before making decisions about personal wellbeing. I look forward to reading more articles like this.
I appreciate the balanced approach in this article. It is good to see the importance of context included in the discussion. This is a useful addition to online health resources.
I appreciate articles that make health topics easier to understand. There is a lot to consider, so a clear overview makes a difference. Thanks for making the subject easier to explore.
There are several useful points here. The explanations make this topic feel less overwhelming. Please continue publishing clear guides on health topics.
I appreciate the effort behind this article. The article highlights why informed choices matter. This is a useful addition to online health resources.
This prospective observational study highlights the practical value of combining preoperative airway ultrasound with routine clinical assessment rather than relying on a single predictor of difficult laryngoscopy. The approach could improve pre-induction risk stratification and support better airway planning.
A clear and engaging piece of writing. I liked the way each part contributed to the overall point.