Use of ultrasonography as a novel tool of airway assessment in patients undergoing general anesthesia and surgery and its comparison with Cormack-Lehane classification: a prospective observational study

Authors

  • Ankita Khalikar Department of Anaesthesiology, MGM Medical College and Hospital, Chhatrapati Sambhajinagar, Maharashtra, India
  • Harmeen Singh Chhabda Department of Anaesthesiology, MGM Medical College and Hospital, Chhatrapati Sambhajinagar, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20261471

Keywords:

Ultrasonography, Airway assessment, Difficult laryngoscopy, Cormack-Lehane classification, General anaesthesia, Endotracheal intubation

Abstract

Background: Accurate preoperative prediction of difficult airway remains a challenge in anesthetic practice. Conventional bedside airway assessment tests have limited sensitivity and specificity. Ultrasonography has emerged as a non-invasive, bedside tool for airway evaluation. This study aimed to assess the role of ultrasonography in predicting difficult laryngoscopy and to compare ultrasonographic airway parameters with the Cormack-Lehane (CL) classification obtained during direct laryngoscopy.

Methods: This prospective observational study was conducted in adult patients undergoing elective surgery under general anesthesia. Preoperative airway assessment included ultrasonographic measurement of airway parameters. After induction of anesthesia, direct laryngoscopy was performed and the laryngeal view was graded according to the CL classification. The correlation between ultrasonographic findings and laryngoscopic grades was analyzed to evaluate the predictive value of ultrasound in identifying difficult laryngoscopy.

Results: Ultrasonographic airway measurements demonstrated a significant correlation with laryngoscopic grading. Patients with increased ultrasonographic airway parameters were more likely to have higher CL grades (Grade III-IV), indicating difficult laryngoscopy. Ultrasonography showed good sensitivity and specificity in predicting difficult airway when compared with conventional airway assessment methods.

Conclusions: Preoperative airway ultrasonography is a simple, non-invasive, and reliable tool for predicting difficult laryngoscopy. It can serve as a valuable adjunct to conventional clinical airway assessment and may improve perioperative airway management strategies.

 

References

Benumof JL. Definition and incidence of difficult airway. In: Benumof JL, editor. Airway Management: Principles and Practice. St Louis: Mosby. 1996;121-5.

Wajekar AS, Chellam S, Toal PV. Prediction of ease of laryngoscopy and intubation: Role of upper lip bite test, modified Mallampati classification, and thyromental distance in various combination. J Family Med Prim Care. 2015;4(1):101-5.

Hall EA, Showaihi I, Shofer FS, Panebianco NL, Dean AJ. Ultrasound evaluation of the airway in the ED: A feasibility study. Crit Ultrasound J. 2018;10(1):3.

Ezri T, Gewürtz G, Sessler DI, Medalion B, Szmuk P, Hagberg C, et al. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia. 2003;58(11):1111-4.

Rana S, Verma V, Bhandari S, Sharma S, Koundal V, Chaudhary SK. Point-of-care ultrasound in airway assessment: A correlation of ultrasonography-guided parameters to the Cormack-Lehane classification. Saudi J Anaesth. 2018;12(2):292-6.

Alessandri F, Antenucci G, Piervincenzi E, Buonopane C, Bellucci R, Andreoli C, et al. Ultrasound as a new tool in the assessment of airway difficulties: An observational study. Eur J Anaesthesiol. 2019;36(7):509-15.

Kajekar P, Mendonca C, Gaur V. Role of ultrasound in airway assessment and management. Int J Ultrasound Appl Technol Perioper Care. 2010;1(2):97-100.

Jain PN, Ranganathan P. Ultrasound in anesthesia. Indian J Anaesth. 2007;51(3):176-83.

Reddy AV, Asim SA, Reddy BS, Rao MV. Utility of ultrasound in preanaesthetic airway assessment. Asian Pac J Health Sci. 2017;4(2):90-2.

Adhikari S, Zeger W, Schmier C, Crum T, Craven A, Frrokaj I, et al. Pilot study to determine the utility of point-of-care ultrasound in the assessment of difficult laryngoscopy. Acad Emerg Med. 2011;18(7):754-8.

Kristensen MS, Teoh WH, Graumann O, Laursen CB. Ultrasonography for clinical decision-making and intervention in airway management: From the mouth to the lungs and pleurae. Insights Imaging. 2014;5(2):253-79.

Reddy PB, Punetha P, Chalam KS. Ultrasonography-A viable tool for airway assessment. Indian J Anaesth. 2016;60(11):807-13.

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(3):353-8.

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Published

2026-05-14

How to Cite

Khalikar, A., & Chhabda , H. S. (2026). Use of ultrasonography as a novel tool of airway assessment in patients undergoing general anesthesia and surgery and its comparison with Cormack-Lehane classification: a prospective observational study. International Journal of Research in Medical Sciences. https://doi.org/10.18203/2320-6012.ijrms20261471

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Original Research Articles