open access

Vol 50, No 2 (2018)
Original and clinical articles
Published online: 2018-06-26
Submitted: 2017-09-15
Accepted: 2018-05-08
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Ultrasound-based assessment of hyomental distances in neutral, ramped, and maximum hyperextended positions, and derived ratios, for the prediction of difficult airway in the obese population: a pilot diagnostic accuracy study

Cristina Petrisor, Robert Szabo, Catalin Constantinescu, Adrian Prie, Natalia Hagau
DOI: 10.5603/AIT.2018.0017
·
Pubmed: 29953573
·
Anaesthesiol Intensive Ther 2018;50(2):110-116.

open access

Vol 50, No 2 (2018)
Original and clinical articles
Published online: 2018-06-26
Submitted: 2017-09-15
Accepted: 2018-05-08

Abstract

Background: Ultrasonography-assessed hyomental distance (HMD) ratio has been found to discriminate between
obese patients with Cormack-Lehane grades 1 or 2 vs. those with grades 3 or 4. The aim of our study is to evaluate
the performance of the HMD evaluated ultrasonographically in neutral, ramped, and maximum hyperextended positions,
as well as for the ratios obtained by dividing the HMD in the ramped position to that in the neutral position
(HMDR1) and by dividing the HMD in maximum hyperextension to that in the neutral position (HMDR2), in order to
predict the occurrence of Cormack-Lehane grades 3 or 4 during direct laryngoscopy.

Methods: Ultrasound measurements were performed preoperatively in 25 patients with morbid obesity, measuring
the HMD in the neutral, ramped, and maximum hyperextended positions. Pre-epyglotic soft tissue thickness,
Mallampati and upper lip bite test scores were recorded. Cormack-Lehane grading was considered as an outcome
variable in the Receiver Operating Characteristics curve analysis.

Results: HMD in the neutral, ramped and maximum hyperextended positions presented similar sensitivities, 100%
[39.8–100.0]. For HMD, specificity was 42.86% [21.8–66.0] in the neutral position, 61.9% [38.4–81.9] in the ramped
postion, and 71.4% [47.8–88.7] in the maximum hyperextended position. For HMDR1, the cut-off value was 1.12. This
threshold provides 75% [19.4–99.4] sensitivity and 76.2% [52.8–91.8] specificity. For HMDR2, a cut-off value of 1.23
provides 100% [39.8–100.0] sensitivity and 90.5% [69.6–98.8] specificity.

Conclusion: HMDR2 seems to have superior diagnostic accuracy in predicting difficult laryngoscopy in the obese
population compared to HMDR1, as well as compared to the HMD in the neutral, ramped, and maximum hyperextended
positions.

Abstract

Background: Ultrasonography-assessed hyomental distance (HMD) ratio has been found to discriminate between
obese patients with Cormack-Lehane grades 1 or 2 vs. those with grades 3 or 4. The aim of our study is to evaluate
the performance of the HMD evaluated ultrasonographically in neutral, ramped, and maximum hyperextended positions,
as well as for the ratios obtained by dividing the HMD in the ramped position to that in the neutral position
(HMDR1) and by dividing the HMD in maximum hyperextension to that in the neutral position (HMDR2), in order to
predict the occurrence of Cormack-Lehane grades 3 or 4 during direct laryngoscopy.

Methods: Ultrasound measurements were performed preoperatively in 25 patients with morbid obesity, measuring
the HMD in the neutral, ramped, and maximum hyperextended positions. Pre-epyglotic soft tissue thickness,
Mallampati and upper lip bite test scores were recorded. Cormack-Lehane grading was considered as an outcome
variable in the Receiver Operating Characteristics curve analysis.

Results: HMD in the neutral, ramped and maximum hyperextended positions presented similar sensitivities, 100%
[39.8–100.0]. For HMD, specificity was 42.86% [21.8–66.0] in the neutral position, 61.9% [38.4–81.9] in the ramped
postion, and 71.4% [47.8–88.7] in the maximum hyperextended position. For HMDR1, the cut-off value was 1.12. This
threshold provides 75% [19.4–99.4] sensitivity and 76.2% [52.8–91.8] specificity. For HMDR2, a cut-off value of 1.23
provides 100% [39.8–100.0] sensitivity and 90.5% [69.6–98.8] specificity.

Conclusion: HMDR2 seems to have superior diagnostic accuracy in predicting difficult laryngoscopy in the obese
population compared to HMDR1, as well as compared to the HMD in the neutral, ramped, and maximum hyperextended
positions.

Get Citation

Keywords

airway assessment, ultrasonography; difficult airway, difficult laryngoscopy

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Title

Ultrasound-based assessment of hyomental distances in neutral, ramped, and maximum hyperextended positions, and derived ratios, for the prediction of difficult airway in the obese population: a pilot diagnostic accuracy study

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 50, No 2 (2018)

Pages

110-116

Published online

2018-06-26

DOI

10.5603/AIT.2018.0017

Pubmed

29953573

Bibliographic record

Anaesthesiol Intensive Ther 2018;50(2):110-116.

Keywords

airway assessment
ultrasonography
difficult airway
difficult laryngoscopy

Authors

Cristina Petrisor
Robert Szabo
Catalin Constantinescu
Adrian Prie
Natalia Hagau

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