Ultrasound-measured tongue thickness: a marker of difficult mask ventilation, prospective observational study

Abstract

Background: Unanticipated difficult airways pose major issues for anesthesiologists every time they encounter them. Mask ventilation is a basic skill that can help in any emergency scenario. Our primary goal was to verify the role of upper airway ultrasound, mainly tongue thickness, as a parameter for predicting difficult mask ventilation.

Methods: We conducted a prospective observational study involving 125 patients scheduled for elective surgical procedures requiring general anesthesia and endotracheal intubation. Preoperative clinical assessment and ultrasound assessment of tongue thickness in the submental mid-sagittal plane were performed to predict a difficult airway. We compared the parameters associated with difficulties encountered during airway management, including mask ventilation and intubation.

Results: The thickness of the base of the tongue was greater than 4.06 cm, confirming difficulty in mask ventilation, and the thickness of the body of the tongue was greater than 5.36 cm, confirming difficulty in intubation. Ultrasound plays a major supporting role in assessing difficulties.

Conclusions: Preoperative ultrasound airway assessment provides valuable insights into airway management. This can be incorporated into routine clinical practice alongside standard clinical assessment to minimize adverse events associated with airway management.