Clinical Research Directory

Relationship of Isthmus Thickness With Difficult Laryngoscopy and Difficult Intubation in Patients Receiving Hypothyroidism Treatment

Under general anesthesia, the rate of failed intubation ranges from 1.5% to 13%, raising concerns among anesthesiologists whose primary goal is successful airway management. In this context, various physical and ultrasonographic measurement techniques have been developed to predict difficult intubation. Ultrasonography is effectively used for estimating tracheal tube size, device placement, diagnosing upper airway pathologies, and guiding percutaneous tracheostomy. In thyroid pathologies, intubation difficulty may increase; however, the impact of goiter remains debatable, as some conditions causing hypothyroidism are reported to lead to thyroid gland atrophy rather than hypertrophy. The study's hypothesis is that an atrophic or fibrotic thyroid isthmus may be associated with difficult laryngoscopy and intubation. Evaluation will be performed using the Cormack-Lehane score (Grade III-IV) and the Intubation Difficulty Scale (IDS \>5). The aim is to determine the relationship between thyroid isthmus thickness and difficult laryngoscopy and intubation during elective intubation in patients receiving hypothyroidism treatment. Preoperatively, patients' demographic and clinical data (age, gender, height, weight, BMI, comorbidities, ASA score, thyroid medication dose, treatment duration, and type of thyroid disease) will be recorded. In the premedication room, after administering 0.01 mg/kg IV midazolam, the distance between the thyroid isthmus and the skin will be measured using a linear ultrasound probe (3-13 Hz) in the supine position with neck hyperextension at the level of the 2nd-3rd tracheal rings; the average of three measurements will be recorded. In the operating room, under noninvasive monitoring and following mask pre-oxygenation, anesthesia induction will be performed using IV 2 mg/kg propofol, 1 µg/kg fentanyl, 1 mg/kg lidocaine, and 0.6 mg/kg rocuronium. Once the TOF reaches zero, an experienced anesthesiologist will intubate using a size 3 Macintosh blade for females and size 4 for males with an appropriate endotracheal tube. The intubation time, defined as the interval from laryngoscope insertion until the first capnography wave is detected, will be recorded along with the Cormack-Lehane and EZS scores and the requirement for video laryngoscopy. In cases of failed intubation, the 2022 ASA Difficult Airway Management Guidelines will be applied.

Predicting Difficult Intubation in Bariatric Surgery: Comparison of El Ganzouri Risk Index and Airway Ultrasound

This study is designed as a prospective observational study and will be conducted at the Health Sciences University Antalya Training and Research Hospital. Adult patients scheduled to undergo bariatric surgery will be included. The aim of this study is to compare the El Ganzouri Risk Index (EGRI) and airway ultrasonography (USG) parameters in predicting difficult intubation and to evaluate their relationship with the Cormack-Lehane (CL) score obtained during direct laryngoscopy. Before surgery, each participant will be evaluated using both the EGRI scoring system and airway USG. During general anesthesia, tracheal intubation will be performed using direct laryngoscopy, and data including the CL score, intubation time, number of attempts, and the need for videolaryngoscopy will be recorded based on the anesthesiologist's observations. The collected data will be analyzed by classifying participants according to the presence or absence of difficult intubation, and statistical comparisons will be performed between EGRI scores and airway ultrasonography parameters. The results of this study may contribute to improved preoperative airway assessment and enhanced patient safety in bariatric surgery.

Preoperative Prediction of Difficult Airway in Children

This prospective observational study aims to evaluate the predictive value of preoperative clinical airway assessment parameters for difficult airway management in pediatric patients undergoing elective surgery under general anesthesia. Preoperative clinical measurements and bedside airway tests will be recorded, and their association with intraoperative airway outcomes, including difficult laryngoscopy and difficult intubation, will be analyzed. Difficult laryngoscopy will be defined as Cormack-Lehane grade III-IV, while secondary outcomes will include difficult intubation, difficult mask ventilation, and airway-related complications. The study seeks to identify clinically applicable predictors and improve preoperative risk stratification for pediatric airway management. The findings may contribute to safer anesthetic practice in children by facilitating early identification of patients at increased airway risk.

3D-CT-Based Prediction of Difficult Laryngoscopy in Infants With Pierre Robin Sequence

This study aims to develop and validate a quantitative prediction model using three-dimensional computed tomography (3D-CT) imaging for identifying infants with Pierre Robin sequence (PRS) at risk of difficult laryngoscopy. A dual-parameter model incorporating the oropharyngeal sagittal area (S2) and the distance between the tongue base and the posterior pharyngeal wall (D4) will be established. Internal validation will be performed using data from PRS infants treated between 2023 and 2024, and temporal external validation will be conducted using an independent cohort from 2025. This study seeks to provide an accurate, non-invasive tool for preoperative airway risk assessment in PRS infants, thereby improving anesthetic safety and clinical decision-making.

Ultrasonographic Airway Assessment in Predicting Difficult Laryngoscopy in Pediatric Patients Undergoing Elective Surgery

This study aims to evaluate the diagnostic accuracy of ultrasonographic airway examination in predicting difficult laryngoscopy in pediatric patients undergoing elective surgery.