• Shelly Rana, Versha Verma, Shyam Bhandari, Shalini Sharma, Vishal Koundal, and Sudarshan Kumar Chaudhary.
• Department of Anaesthesia, Dr. Rajendra Prasad Medical Government College, Kangra, Himachal Pradesh, India.
• Saudi J Anaesth. 2018 Apr 1; 12 (2): 292-296.

Background And AimThe sonographic assessment of airway in the preoperative period has encouraging results in predicting difficult laryngoscopy.Materials And MethodsThe prospective, observational study was conducted on 120 patients scheduled for elective surgery requiring general anesthesia and tracheal intubation. The depth of the pre-epiglottic space (Pre-E), the distance from the epiglottis to the midpoint of the distance between the vocal cords (E-VC) was measured sonographically. Similarly, hyomental distance ratio (HMDR) was sonographically measured with head in neutral and extended positions. The primary outcome was the efficacy of Pre E/E-VC, HMDR for predicting difficult laryngoscopy (Cormack-Lehane [CL] Grade 3, 4). The secondary outcome was to correlate these parameters to CL grading.ResultsDifficult intubation was observed in 12.5% of patients. The mean ± standard deviation (SD) of Pre E/E-VC ratio was 1.33±0.335, 1.62±0.264 and 1.87±.243, 2.22±.29 for CL Grade 1, 2, 3, and 4, respectively (P = 0.00). The mean ± SD of HMDR was 1.11±.35, 1.12±.29, and 1.07±.39, 1.04 ± 0.01 for CL Grade 1, 2, 3, and 4, respectively (P = 0.00). Pre E/E-VC ratio of more than 1.77 cm had 82% sensitivity, specificity 80%, whereas HMDR less than1.085 had sensitivity 75% and specificity 85.3%, in predicting difficult laryngoscopy (P = 0.00).ConclusionThe sonographic measurement of the Pre E/E-VC ratio is a better predictor of CL grading as compared to HMDR. The noninvasive prediction of CL grading can be precisely done by Pre-E/E-VC ratio (range: 0-1.425 corresponds to CL Grade 1; 1.425-1.77 ≈ CL Grade 2; 1.77-1.865 ≈ CL Grade 3, more than 1.865 corresponds to CL Grade 4).

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