Diagnosis of difficult airways: a review

Abstract

INTRODUCTION: Complications arising from maintaining the patency of the upper airways in the practice of an anesthetist remain the most dangerous for the life and health of the patient. The problem of predicting difficult airways has been studied for decades and has not yet been solved. OBJECTIVE: To analyze the problem of the difficult airways diagnosis. MATERIALS AND METHODS: There was search on PubMed (MEDLINE), eLibrary, Google Scholar databases for the period 01.1985–01.2022. Keywords: Difficult airways prediction, difficult airways, difficult intubation, mask ventilation, endoscopy intubation, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), difficult airways, difficult intubation, difficult laryngoscopy, mask ventilation, ultrasound diagnostics, computed tomography (CT), magnetic resonance imaging (MRI). Inclusion criteria: original, review articles, randomized and non-randomized clinical trials, meta-analyses and systematic reviews devoted to the diagnosis of TDP. Exclusion criteria: clinical cases, comments on articles, abstracts of dissertations. RESULTS: Measurement of various distances, tests for congenital or acquired deformity of the facial skull and malocclusion, tests for the relationship between the structures of the facial skull and the cervical spine, for the most part, have limited diagnostic effectiveness. The instrumental methods allows diagnosing difficult airways with greater confidence. The thickness of the tongue, the distance from the skin to the epiglottis or vocal folds, and the long epiglottis can accurately predict difficulties at various stages of maintaining airways from face mask ventilation to laryngoscopy and tracheal intubation. Ultrasonography should be considered the most optimal method for diagnosing difficult airways. At the same time, less accurate indicators compared to magnetic resonance and x-ray studies should not stop clinicians, as they are compensated by a faster examination. CONCLUSIONS: Instrumental methods for difficult airways diagnosis are more effective than physical ones.