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AIRWAY AND GASTRIC US
Author(s):
Makris , A.*
Affiliations:
Asklepieion Hospital of Voula, Anaesthesia, Athens, Greece
ESRA Academy. Makris A. Sep 16, 2017; 196166
Dr. Alexandros Makris
Dr. Alexandros Makris
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Abstract
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The increasing familiarity with the use of US technology by anaesthesiologists has led to a growing academic and clinical interest in the use of ultrasonography for optimal airway management.

Since ultrasound waves cannot penetrate air, images of the airway structures differ from the ones anaesthesiologists are familiar with in US guided nerve blocks or even transesophageal echocardiography. Intraluminal air produces comet tail or reverberation artifacts. Bone appears bright and hyperechoic with an acoustic shadow behind. Cartilaginous structures like thyroid, cricoid and trachea are homogeneous and hypoechoic but tend to calcify with age. Muscle and connective tissue are heterogeneously striated and hypoechoic. Fatty and glandular (submandibular, thyroid) tissues are homogeneous and hyperechoic in comparison with adjacent soft tissues.

So, US technology can be used to visualize and examine the airway and its surroundings from the tip of the chin up to the trachea. Results of this examination may assist in several aspects the evaluation of the airway. It has been used in order to determine airway size and estimate appropriate endotracheal tube (ETT) size (assessing the narrowest diameter of the cricoid lumen),  to predict difficult laryngoscopy (visualization of hyoid bone, measurement of pretracheal tissue and hyomental distance), to verify ETT position in situations involving cardiovascular arrest where capnography is not indicative, to facilitate awake intubation using US guided upper airway anaesthesia and  identifying cricothyroid membrane before management of a difficult airway.

Additionally, US is used in diagnosing intraoperative pneumothorax and in assessing gastric content and volume, that can help determine aspiration risk. 

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