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. 2023 Oct-Dec;39(4):583-586.
doi: 10.4103/joacp.joacp_113_22. Epub 2022 Sep 2.

Utilization of submandibular ultrasound in assessing upper airway changes following the administration of propofol

Erica V Chemtob  1 , Dora H Lin  2   3 , Esther Lee  4 , Eric R Heinz  2
Affiliations

Utilization of submandibular ultrasound in assessing upper airway changes following the administration of propofol

Erica V Chemtob et al. J Anaesthesiol Clin Pharmacol. 2023 Oct-Dec.

Abstract

Background and aims: Our study aimed to use submandibular ultrasound to measure upper airway parameters before and after induction dose of propofol in order to further understand upper airway changes that occur during induction of anesthesia. Measuring the changes that occur in airway anatomy due to the hypotonic effects of induction agents will allow for a deeper understanding of airway management.

Material and methods: We enrolled 39 patients between November 2021 and January 2022. Submandibular ultrasound was used to measure tongue thickness, geniohyoid muscle thickness, the distance between the lingual arteries (DLA), lateral pharyngeal wall thickness, and hyomental distance before and after administration of induction doses of the commonly used, sedative-hypnotic agent, propofol.

Results: The mean DLA increased significantly after propofol administration, from 3.62 ± 0.63 cm to 3.79 ± 0.56 cm (P < 0.001). The mean tongue thickness was 4.89 ± 0.51 cm and decreased significantly to a mean of 4.62 ± 0.50 cm after propofol administration (P < 0.001). The change in DLA measurements after propofol administration decreased significantly as STOP-BANG score increased (r = -0.344, P = 0.037). However, DLA measurements when patients were awake increased significantly with an increase in the STOP-BANG score (r = 0.351, P = 0.031).

Conclusion: These findings suggest that propofol widens and flattens the tongue, which are changes that may contribute to difficult airway management. Given the quick and non-invasive nature of ultrasound, further studies should evaluate the role of submandibular ultrasound for understanding the upper airway and airway management in various populations.

Keywords: Airway management; airway obstruction; anesthesia; propofol; ultrasonography.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Airway anatomy measurements using submandibular ultrasound. (a) Sagittal scan showing the dorsal surface of the tongue (DT), hard palate (HP), and tongue thickness (white line). (b) Distance between the lingual arteries (white line) using a transverse scan with colorimetric flow
See this image and copyright information in PMC

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