Evaluation of 2 ultrasonic indicators as predictors of difficult laryngoscopy in pregnant women A prospective, double blinded study

Background: Ultrasonic measurements of tongue thickness and condylar translation were recently introduced to predict difficult laryngoscopy in non-obstetric patients. We designed the present study to evaluate the performance of these two ultrasonic indicators in predicting difficult laryngoscopy in healthy parturients. Methods: The 119 parturients undergoing elective cesarean delivery were enrolled. Tongue thickness and condylar translation measured by ultrasonography, and Modified Mallampati test (MMT) score, inter-incisor distance (IID) and modified Cormack-Lehane grading system (MCLS) were measured and recorded before anesthesia. The primary outcome was difficult laryngoscopy defined as MCLS 3 or 4. The association between these variables and difficult laryngoscopy were analyzed by using multivariable logistic regression and receiver operating characteristic (ROC) curve. Results: Compared to the Easy Laryngoscopy Group, the tongue thickness was significantly higher and the condylar translation and IID were significantly lower in the Difficult Laryngoscopy Group. Tongue thickness and condylar translation but not MMT score and IID were proved to be two independent predictors for difficult laryngoscopy by multivariate logistic regression, with the odds ratios of 2.554 (95% confidence interval (CI), 1.715 to 3.802) and 0.457 (95% CI, 0.304 to 0.686). The area under the ROC curve to predict difficult laryngoscopy for tongue thickness was 0.93 (95% CI, 0.88-0.98) and for condylar translation was 0.77 (95% CI, 0.67-0.86), which were significantly higher than those for MMT score (0.67, 95% CI, 0.56-0.77) and IID (0.65, 95% CI, 0.55-0.76). Conclusions: Compared with MMT and IID, tongue thickness and condylar translation measured by ultrasonography appear to be better indicators for predicting difficult laryngoscopy in parturients. The trial was registered at the Chinese Clinical Trial Registry (ChiCTR)(), registration number ChiCTR-ICR-1800019991.