الفهرس 
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Abstract
Institutional approval and informed consents were obtained from all patients before conducting this prospective cohort, double-blind, single-center study, which was conducted at the department of anaesthesia and intensive care at Minia-University Hospital between May 2022 and November 2022 on a total of 349 participants (ASA) physical status I-III who underwent urgent surgical operations under general anaesthesia.
This study aimed evaluate the use of airway ultrasonography in prediction of difficult laryngoscopy (DL) in obese patient who were undergoing urgent surgeries through assessing the airway preoperatively by using clinical screening test and ultrasound of anterior neck soft tissue and investigate if there is any correlation with the Cormack–Lehane grade.
Patients enrolled in the study were divided into two groups of 349 patients:
1- group I (C group): 157 non-obese patients with BMI<30 kg\m2.
2- group II (O group):192 obese patients with BMI>30 kg\m2.
The two groups were compared with respect to: -
Body mass index (BMI).
Comorbidities as hypertension, DM, asthma and cardiovascular diseases.
Clinical screening tests as following:
Modiefied Malmpatie score. -
Neck circumference. -
Upper lip bite test. -
Interincisor gap. -
Mouth opening. -
Thyromental distance. -
Sternomental distance. -
Ultrasonographic assessment of anterior neck soft tissue and confirmation of intubation.
Cormack lehane score.
Complication such as bleeding per gums and loose tooth.
Tools that facilitate intubation in cases of difficult intubation.
Our result recorded a significant higher body mass index in obese group than that in C group.
Comorbidities were significantly higher incidence in obese patients than non-obese.
Regarding clinical screening test as (modified malmpatie score, neck circumference, upper lip bite test, interincisor gap, mouth opening, thyromental and sternomental distances) and associated prediction of difficult intubation were significantly higher in obese group than C group.
In the use of ultrasound in the assessment of difficult airway using distance from skin to epiglottis and per epiglottic distance, there were a higher incidence of difficult airway in obese 39.6% than 26.8% in non-obese.
Also using sonar in confirmation of intubation was significantly difference between the two studied groups.
Difficult intubation incidence using Cormack lehane score were significantly higher in obese patients 20.3% than 12.1% in C group.
Complications were more related to obese patients than non-obese as incidence were 5.2% than 1.3% respectively.
Using of facilitating tools as stylet or bougie and the need for help of other anesthesiologist for intubation of difficult airway patients were associated with higher incidence in obese patients.
Our study proved that there was a correlation between ultrasound and Cormack lehane score in incidence of difficult airway intubation in obese group.
It is worth to be mentioned that both DSEM& PES recorded high Sensitivity and specificity and accuracy with superiority of DSEM as PPV and accuracy were (59 and 85.4) Vs (50 and 79.7) in PES.