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Ultrasound-Assisted Evaluation of the Airway in Clinical Anesthesia Practice: Past, Present and Future

Introduction: The incidence of difficulties encountered in perioperative airway management has been reported to range from 1% to 4%. In patients with head and neck cancers, the incidence can be dramatically higher. Because of high quality of imaging, non-invasiveness and relatively low cost, ultrasonography has been utilized as a valuable adjunct to the clinical assessment of the airway. A review of the literature was conducted with the objective of summarizing the available evidence concerning the use of ultrasound (US) for assessment of the airway, with special emphasis on head and neck cancers.

Methods and Materials: A systematic search of the literature in the MEDLINE database was performed. A total of 42 manuscripts from 329 searched articles were included in this review.

Results: Ultrasonography was found to give high-resolution images of the anatomic structures of the upper airway comparable to computed tomography and magnetic resonance imaging. Several ultrasonographic parameters (soft tissue thickness at level of hyoid bone, epiglottis and vocal cords, visibility of hyoid bone in sublingual ultrasound, hyomental distance in head-extended position and hyomental distance ratio) were found to be independent predictors of difficult laryngoscopy in obese and non-obese patients. In conjunction with elastosonography, it also provided valuable information regarding tumors, infiltration, and edema as well as fibrosis of the head and neck.

Conclusion: Ultrasound-assisted evaluation of the difficult airway offers many important advantages. The ready availability of US machines in anesthesiology departments, familiarity of anesthesia providers with US guided procedures and the portability of US machines allow real-time, point-of-care assessment. It will undoubtedly become more popular and will greatly contribute to improve perioperative patient safety.


Gausan Ratna Bajracharya, Angela T Truong, Dam-Thuy Truong, Juan Pablo Cata

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