Analysis of anterior soft tissue thickness using ultrasonogram, body mass index and neck circumference in predicting difficult intubation

2018 ◽  
Vol 7 (1) ◽  
pp. 40-42
Author(s):  
B Ravindran ◽  
◽  
V Murali Magesh ◽  
B Vignesh ◽  
K Vinoth Kumar ◽  
...  
2019 ◽  
Vol 98 (7) ◽  
pp. E81-E86 ◽  
Author(s):  
Mehmet Surmeli ◽  
Ildem Deveci ◽  
Hasan Canakci ◽  
Mustafa Salih Canpolat ◽  
Burak Karabulut ◽  
...  

In this study, we aimed to investigate the relationship between the body mass index (BMI) and the morphometric properties of auricula and its acoustic gain characteristics. A total of 45 participants between 18 and 45 years of age were enrolled into the study. Participants’ height and weight measurements were recorded for the BMI calculation. On both sides, the morphometric properties of the auricula were measured and recorded. Additionally, the participants were subjected to multidirectional dynamic real ear measurements (REMs) to specify the intensity and frequency values of the maximum hearing gain. Participants consisted of 24 women and 21 men. The mean BMI was 23.42. The mean auricular area was 22.70 cm2. Statistically significant positive correlation was found between the auricular area and BMI ( r = 0.427, P = .03). The mean postauricular sulcus angle was 20.99°. The mastoid-helix distance was 16.07 mm. There was no statistically significant correlation between BMI level and postauricular sulcus angle and mastoid-helix distance ( P > .05). The mean dynamic REM measurement was evaluated. The maximum acoustic gain at anterior, lateral, and posterior vectorial stimulation was calculated as 20.9, 24.2, and 20.7 dB Sound Presure Level (SPL), respectively. Statistically significant negative correlation was found between the three directions acoustic gain level and BMI in the statistical examination ( r = −0.365, r = −0.386, r = −0.453, respectively, and P < .05 for all). The results of acoustic gain frequency were 2967.4, 2963, and 2934 Hz, respectively. There was no statistically significant correlation between acoustic gain frequency and BMI ( P > .05). When participants were grouped according to their BMI, participants with a BMI >25 had a statistically significantly bigger auricular area and lower maximum acoustic gain when compared with those with BMI <25 ( P < .05). We found that the auricular area increased with BMI. We think that this is related to soft tissue thickening of the auricula related to high BMI. In addition, we found that the acoustic gain level decreased inversely with BMI. We believe that the decrease in acoustic gain is due to the increase of acoustic resistance after the increase of soft tissue thickness. In conclusion, we think that BMI has a negative effect on auditory function according to findings in our study.


Author(s):  
Saumya Jain ◽  
Nisha Kachru ◽  
Rupesh Yadav

Background: The incidence of unanticipated difficult airway is 14.3-17.5% in obese. Preoperative difficult airway prediction is important to avoid postoperative morbidity and mortality. USG guided measurement of anterior neck soft tissue thickness can be used to predict difficult laryngoscopy in obese patients and we thus undertook this study to determine the role of USG guided measurement of anterior neck thickness at the level of vocal cords in difficult laryngoscopy prediction. Methods: Sixty obese patients (BMI≥30kg/m2), 18-70 years of age of either sex, were included. Anterior neck soft tissue thickness was measured by ultrasound as the distance from the skin to the anterior commissure of vocal cord. Neck circumference was measured at mid neck just below the laryngeal prominence with the subjects standing upright and facing forward with shoulders relaxed. Thyromental distance, sternomental distance, Mallampatti score and neck circumference were also recorded. Results: The cut off values of BMI (46.94 kg/m2), neck circumference (41.5 cm) and anterior neck soft tissue thickness (22.1mm). Four patients in the morbidly obese and 80% of the superobese patients had a difficult laryngoscopy. Sixteen (26.67%) patients had an anterior neck soft tissue thickness of >22.1mm. Of these, 11 (91.67%) patients had difficult laryngoscopy while one (8.33%) patient with anterior neck soft tissue thickness ≤ 22.1mm had difficult laryngoscopy (P<0.05). There was also significant association between neck circumference and BMI. Conclusion: The USG guided measurement of anterior neck soft tissue thickness, BMI and neck circumference can reliably predict difficult laryngoscopy in obese patients.


2019 ◽  
Vol 23 (3) ◽  
pp. 297-302 ◽  
Author(s):  
Julia D. Sharma ◽  
Kiran K. Seunarine ◽  
Muhammad Zubair Tahir ◽  
Martin M. Tisdall

OBJECTIVEThe aim of this study was to compare the accuracy of optical frameless neuronavigation (ON) and robot-assisted (RA) stereoelectroencephalography (SEEG) electrode placement in children, and to identify factors that might increase the risk of misplacement.METHODSThe authors undertook a retrospective review of all children who underwent SEEG at their institution. Twenty children were identified who underwent stereotactic placement of a total of 218 electrodes. Six procedures were performed using ON and 14 were placed using a robotic assistant. Placement error was calculated at cortical entry and at the target by calculating the Euclidean distance between the electrode and the planned cortical entry and target points. The Mann-Whitney U-test was used to compare the results for ON and RA placement accuracy. For each electrode placed using robotic assistance, extracranial soft-tissue thickness, bone thickness, and intracranial length were measured. Entry angle of electrode to bone was calculated using stereotactic coordinates. A stepwise linear regression model was used to test for variables that significantly influenced placement error.RESULTSBetween 8 and 17 electrodes (median 10 electrodes) were placed per patient. Median target point localization error was 4.5 mm (interquartile range [IQR] 2.8–6.1 mm) for ON and 1.07 mm (IQR 0.71–1.59) for RA placement. Median entry point localization error was 5.5 mm (IQR 4.0–6.4) for ON and 0.71 mm (IQR 0.47–1.03) for RA placement. The difference in accuracy between Stealth-guided (ON) and RA placement was highly significant for both cortical entry point and target (p < 0.0001 for both). Increased soft-tissue thickness and intracranial length reduced accuracy at the target. Increased soft-tissue thickness, bone thickness, and younger age reduced accuracy at entry. There were no complications.CONCLUSIONSRA stereotactic electrode placement is highly accurate and is significantly more accurate than ON. Larger safety margins away from vascular structures should be used when placing deep electrodes in young children and for trajectories that pass through thicker soft tissues such as the temporal region.


BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044228
Author(s):  
Henry Oliveros ◽  
Rafael Lobelo ◽  
Luis Fernando Giraldo-Cadavid ◽  
Alirio Bastidas ◽  
Constanza Ballesteros ◽  
...  

ObjectivesObstructive sleep apnoea (OSA)/hypopnoea syndrome is associated with serious and major multiorgan morbidities, particularly in its most severe forms. However, no severe OSA screening instruments are available for high altitude residents that enable adequate identification and clinical prioritisation of such patients. We aimed at developing a severe OSA prediction tool based on the clinical characteristics and anthropometric measurements of a clinical referral cohort living at 2640 m.a.s.l.DesignCohort-nested cross-sectional study.SettingSleep laboratory for standard polysomnography (PSG) in Colombia.ParticipantsA predictive model was generated from 8718 participants referred to the PSG laboratory. Results were subsequently validated in a second cohort of 1898 participants.Primary outcomeTo identify clinical and anthropometric variables associated with severe OSA (>30 events/hour) and to include them in a binary logistic regression model.ResultsThe significant variables that were retained with the presence of severe OSA included Body mass index (BMI), Age, Sex, Arterial hypertension and Neck circumference (BASAN). The area under the receiver operating characteristic curvefor the BASAN index was 0.69 (95% CI: 0.68 to 0.70) in the derivation cohort and 0.67 (95% CI: 0.65 to 0.69) in the validation cohort, whereby a BASAN index ≥2 had a sensitivity of 95% and a specificity of 17% to detect severe OSA.ConclusionAn objectively based approach to screen for the presence of severe OSA, the BASAN index, exhibits favourable sensitivity characteristics that should enable its operational use as a screening tool in a Hispanic population with a clinical suspicion of OSA and living at high altitude.


2021 ◽  
pp. 200460
Author(s):  
Diana Toneva ◽  
Silviya Nikolova ◽  
Stanislav Harizanov ◽  
Dora Zlatareva ◽  
Vassil Hadjidekov

Author(s):  
Mohammed Mousa Bakri ◽  
Sung Ho Lee ◽  
Jong Ho Lee

Abstract Background A compact passive oxide layer can grow on tantalum (Ta). It has been reported that this oxide layer can facilitate bone ingrowth in vivo though the development of bone-like apatite, which promotes hard and soft tissue adhesion. Thus, Ta surface treatment on facial implant materials may improve the tissue response, which could result in less fibrotic encapsulation and make the implant more stable on the bone surface. The purposes of this study were to verify whether surface treatment of facial implant materials using Ta can improve the biohistobiological response and to determine the possibility of potential clinical applications. Methods Two different and commonly used implant materials, silicone and expanded polytetrafluoroethylene (ePTFE), were treated via Ta ion implantation using a Ta sputtering gun. Ta-treated samples were compared with untreated samples using in vitro and in vivo evaluations. Osteoblast (MG-63) and fibroblast (NIH3T3) cell viability with the Ta-treated implant material was assessed, and the tissue response was observed by placing the implants over the rat calvarium (n = 48) for two different lengths of time. Foreign body and inflammatory reactions were observed, and soft tissue thickness between the calvarium and the implant as well as the bone response was measured. Results The treatment of facial implant materials using Ta showed a tendency toward increased fibroblast and osteoblast viability, although this result was not statistically significant. During the in vivo study, both Ta-treated and untreated implants showed similar foreign body reactions. However, the Ta-treated implant materials (silicone and ePTFE) showed a tendency toward better histological features: lower soft tissue thickness between the implant and the underlying calvarium as well as an increase in new bone activity. Conclusion Ta surface treatment using ion implantation on silicone and ePTFE facial implant materials showed the possibility of reducing soft tissue intervention between the calvarium and the implant to make the implant more stable on the bone surface. Although no statistically significant improvement was observed, Ta treatment revealed a tendency toward an improved biohistological response of silicone and ePTFE facial implants. Conclusively, tantalum treatment is beneficial and has the potential for clinical applications.


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