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This prospective observational study aims to evaluate the predictive value of ultrasound-measured skin-to-epiglottis distance for difficult airway in adult patients undergoing elective or emergency procedures requiring airway management. The correlation between ultrasound measurements and standard airway assessment parameters will be analyzed.
Airway management is a critical component of anesthesia and intensive care practice. Predicting difficult airway remains challenging with conventional bedside tests. Ultrasound has emerged as a non-invasive, bedside tool for airway assessment. This study aims to investigate the relationship between skin-to-epiglottis distance measured by ultrasound and difficult laryngoscopy/intubation. Secondary comparisons will include traditional airway assessment methods such as Mallampati score, thyromental distance, and neck circumference
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| Measure | Description | Time Frame |
|---|---|---|
| Skin-to-epiglottis distance | Distance measured via ultrasound in the anterior neck region | Pre-intubation (within 30 minutes before procedure) |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of difficult laryngoscopy (Cormack-Lehane grade ≥ 3) | The proportion of patients with difficult laryngoscopy defined as Cormack-Lehane grade 3 or 4 during direct laryngoscopy. | During intubation procedure (intraoperative period) |
| Intubation Difficulty Score (IDS) |
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Inclusion Criteria:
Exclusion Criteria:
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The study population consists of adult patients scheduled for elective surgery requiring tracheal intubation under general anesthesia. Patients will be recruited from the preoperative anesthesia clinic at [Hacettepe University Faculty of Medicine]
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Almıla G Pamuk, Doç. Dr. | Contact | 9005335296325 | 03123051207 | gulsunp@yahoo.com |
| muhammed r hız, research assistant | Contact | 9005417800327 | 9003123051207 | drrasithiz@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Almıla g Pamuk, Doç Dr. | Hacettepe Univercity | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hacettepe Univercity | Ankara | Altındağ | 06320 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Gani, E. (2020). Obez hastalarda zor entübasyonun öngörülmesinde ultrasonla ölçülen cilt-epiglot mesafesinin önemi (Tıpta Uzmanlık Tezi). Düzce Üniversitesi, Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Düzce. | ||
| 30139232 | Background | Uzumcugil F, Celebioglu EC, Ozkaragoz DB, Yilbas AA, Akca B, Lotfinagsh N, Celebioglu B. Body Surface Area Is Not a Reliable Predictor of Tracheal Tube Size in Children. Clin Exp Otorhinolaryngol. 2018 Dec;11(4):301-308. doi: 10.21053/ceo.2018.00178. Epub 2018 Aug 25. | |
| 41203471 |
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Diffuculty airway
10/2026 -- 01/2027
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Assessment of intubation difficulty using the Intubation Difficulty Score based on number of attempts, operators, alternative techniques, glottic exposure, lifting force, external laryngeal pressure, and vocal cord position. |
| During intubation procedure |
| Correlation between ultrasound measurements and Mallampati score | Correlation between tracheal diameter and skin-to-epiglottis distance measured by ultrasound and preoperative Mallampati classification. | Preoperative assessment |
| Background |
| Ahmad I, El-Boghdadly K, Iliff H, Dua G, Higgs A, Huntington M, Mir F, Nouraei SAR, O'Sullivan EP, Patel A, Rivett K, McNarry AF. Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults. Br J Anaesth. 2026 Jan;136(1):283-307. doi: 10.1016/j.bja.2025.10.006. Epub 2025 Nov 7. |
| 40142901 | Background | Altinsoy KE, Bayhan BU. Ultrasound-Measured Skin-to-Epiglottis Distance as a Predictor of Difficult Intubation in Obese Patients: A Prospective Observational Study. J Clin Med. 2025 Mar 19;14(6):2092. doi: 10.3390/jcm14062092. |
| 39176250 | Background | Sayir TN, Tuncer B, Erkilic E. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population. Open Med (Wars). 2024 Aug 21;19(1):20241013. doi: 10.1515/med-2024-1013. eCollection 2024. |
| 39029084 | Background | Cinar Kose EO, Tekin M, Cesur S, Cam I, Baykara ZN. Evaluation of neck ultrasound measurements as a difficult airway predictor: A prospective observational study. Medicine (Baltimore). 2024 Jul 19;103(29):e38591. doi: 10.1097/MD.0000000000038591. |
| 32346164 | Background | Daggupati H, Maurya I, Singh RD, Ravishankar M. Development of a scoring system for predicting difficult intubation using ultrasonography. Indian J Anaesth. 2020 Mar;64(3):187-192. doi: 10.4103/ija.IJA_702_19. Epub 2020 Mar 11. |
| 34217221 | Background | 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 Jul 3;21(1):76. doi: 10.1186/s12873-021-00472-w. |
| 21447488 | Background | Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011 May;106(5):617-31. doi: 10.1093/bja/aer058. Epub 2011 Mar 29. |
| 40499971 | Background | Zhang W, Du L, Huang Y, Liu D, Li T, Zheng J. Artificial intelligence for difficult airway assessment: a protocol for a systematic review with meta-analysis. BMJ Open. 2025 Jun 10;15(6):e096744. doi: 10.1136/bmjopen-2024-096744. |
| 29889671 | Background | Falcetta S, Cavallo S, Gabbanelli V, Pelaia P, Sorbello M, Zdravkovic I, Donati A. Evaluation of two neck ultrasound measurements as predictors of difficult direct laryngoscopy: A prospective observational study. Eur J Anaesthesiol. 2018 Aug;35(8):605-612. doi: 10.1097/EJA.0000000000000832. |
| ID | Term |
|---|---|
| D014133 | Tracheal Diseases |
| ID | Term |
|---|---|
| D012140 | Respiratory Tract Diseases |
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