Ultrasound-Guided Airway Assessment in Obese Patients Undergoing Bariatric Surgery a Randomized Clinical Trial

Introduction: Anesthetic planning for obese patients must be effective to avoid unexpected adverse events. The introduction of ultrasound (USG) in medicine has made it possible to identify, assess, and predict the possibility of Difficult Airway (DA).Objective: To evaluate whether ultrasound parameters can be predictors of DA in the obese patient population. Furthermore, to establish correlations between traditional DA indicators and the parameters obtained by ultrasound, with the goal of verifying the agreement and accuracy between the methods. Method: A randomized clinical trial compared the assessment of already validated clinical indicators for predicting DA and USG parameters defined after a literature review. Results: 132 individuals were randomized, subdivided into 66 patients in the conventional airway assessment group and 53 patients in the conventional airway assessment + USG group. The evaluation of basic patient characteristics in the USG and conventional groups showed that both groups were homogeneous in terms of weight (114.3 ± 16.9 kg vs. 116.9 ± 23.8 kg, p: 0.51), height (165.6 ± 8.0 cm vs. 166.3 ± 8.9 cm, p: 0.66), and body mass index (BMI) (41.7 ± 5.7 vs. 42.0 ± 6.6, p: 0.76). USG evaluation of the airway showed that the skin-epiglottis distance (SED) was < 2.7 cm in 73.3% of patients in the USG group, and the skin-hyoid distance (SHD) was < 1.41 cm in 60.4%. The primary outcome was the occurrence of Difficult Intubation (DI), which was significantly higher in the USG group (18.9%) compared to the conventional group (4.5%, p: 0.01). There was no significant difference in the use of a videolaryngoscope (22.6% in the USG group vs. 16.7% in the conventional group, p: 0.42) or intubation-related complications. Conclusion: The integration of USG proved advantageous in clinical practice for airway assessment, reducing the incidence of intubation-related complications and improving the potential management of complex cases.