Overview
Endotracheal intubation can induce laryngotracheal injury which results in narrowing of the airway due to edema of the glottis. This can increase the risk of development of post-extubation stridor (PES)
Description
Ultrasound (US) is a useful and non-invasive tool for the evaluation of vocal cords and laryngeal morphology in intubated patients. The laryngeal air-column width (LACW), Laryngeal air column width difference (LACWD), and laryngeal air-column width ratio (LACWR) measured by ultrasound can potentially identify patients at risk of post-extubation stridor, in whom caution should be taken after extubation.
The cuff-leak test can predict successful extubation through using the difference between the expired tidal volume with the cuff inflated and with the cuff deflated; the higher the leak, the lower the likelihood that post-extubation stridor will occur.
Eligibility
Inclusion Criteria:
- Adult patients (\>18 years)
- American Society of Anesthesiologists status I and II
- undergoing elective maxillomandibular fixation surgeries under general anesthesia with nasal endotracheal intubation
Exclusion Criteria:
- patients' refusal
- pregnant females
- patients with body mass index \<18.5 or ≥ 35 kg/m2
- risk of aspiration
- cardiorespiratory disorder
- neuromuscular disease
- uncontrolled diabetes mellitus
- gastrointestinal bleeding
- on chronic steroid therapy
- intubated patients or were intubated or had upper airway infection within 1 week prior to surgery
- history of any pathology, radiotherapy or surgery in the neck
- had difficult laryngeal US plane (as neck wound)
