Evaluation of ultrasound guided measurement of tongue thickness in predicting difficult intubation in obese patients.

INTRODUCTION: Managing the airway presents a significant challenge in anesthesia, particularly in obese patients, and is a leading cause of morbidity and mortality associated with anesthesia. Although increased tongue thickness in the obese is generally assumed to be associated with a difficult intubation. So that aim of this study was to evaluate ultrasound guided measurement of tongue thickness in predicting difficult tracheal intubation in obese patients. MATERIALS AND METHODS: Study included 45 patients aged 18 to 65 of any gender. These patients, classified as American Society of Anesthesiologists Grade I and II, had a Body mass index exceeding 30 kg/m2. Tongue thickness was evaluated using ultrasound, measuring the distance from the tongue surface to the submental skin, while also documenting the modified Mallampatti score (MMP). Number of attempts for intubation, time taken for intubation and use of any alternate device or technique were noted. RESULTS: The tongue thickness cutoff for predicting difficult intubation was determined to be 6.5 cm. The Receiver operating characteristic (ROC) curve analysis revealed an AUC (Area under the ROC Curve) of 0.920 (Standard Error: 0.230, 95% Confidence interval: 0.850-0.950) for a cutoff value exceeding 6.5 cm, indicating excellent predictive capability. Tongue thickness demonstrated a combined diagnostic accuracy of 95.5%, with sensitivity and specificity of 75% and 97.5% respectively. MMP grade was compared with tongue thickness, a positive correlation was seen with co-efficient of 0.45. There was a statistically significance (p value <0.001). CONCLUSIONS: This study concludes that ultrasound guided measurement of tongue thickness > 6.5 cm can reliably predict difficult tracheal intubation in obese patients.