Title: Preoperative Airway Assessment for Anticipation of Difficult Bag and Mask Ventilation Using Standard Clinical Parameters and Ultrasound Parameters in Patients Having BMI >23KG/M2

Authors: Dr Kanika Sharma, Dr Kartik Syal, Dr Rajesh Verma, Dr Surinder Singh

 DOI: https://dx.doi.org/10.18535/jmscr/v8i6.47

Abstract

Introduction

Successful airway management requires a range of knowledge and skills to predict difficulty and to formulate an airway management plan as well as to have the skills necessary to execute the plan using the wide array of airway devices available. Effective bag and mask ventilation is most important step in securing the air way. Various studies had shown that the incidence of difficult bag and mask ventilation in overweight patients is approximately 6% whereas in lean patients is approximately 1%.1

Clinical criteria’s routinely used to assess patients prior to anesthesia have variations according to patient’s height, weight and ethnicity.

Ultrasonography (USG) is well-known as a fast, safe and noninvasive technique. There were very limited studies which showed value of USG derived parameters in assessing airway for anticipation of difficult BMV in obese patients and its co-relation with proven clinical parameters. The clinical parameters i.e. MPS, TMD (thyromental distance), NC (neck circumference) were included in the present study. The USG derived parameters, preepiglotic space depth (PES), epiglottis to vocal cord distance (EVC), skin to dorsum of tongue distance (S-DT) are the USG parameters taken and clinically assessed parameters and USG parameters were co-related with each other taking BMV grading as reference.    

References

  1. Shailaja S, Nichelle SM, Shetty AK, Hegde BR. Comparing ease of intubation in obese and lean patients using intubation difficulty scale. Anesth Essays Res 2014; 8: 168-74.
  2. Lee SY, Chien DK, Huang MY, Huang CH, Shih SC, Wu KM, Ku HC, Chang WH. Patient specific factors associated with difficult mask ventilation in emergency department. IJGE  2017; 11(4): 263-6.
  3. Kheterpal S, Martin L, Shanks, AM, and Tremper KK. Prediction and outcomes of impossible mask ventilation. Anesthesiology 2009; 110: 891–7.
  4. Leoni A, Arlati S, Ghisi D. Difficult mask ventilation in obese patients: analysis of predictive factors. Minerva Anestesiol 2014; 80(2): 149-57.

Corresponding Author

Dr Kanika Sharma

Medical Officer Specialist (Anesthesia) at DDUZH Shimla H.P