To assess the impact of advanced airway imaging (3D CT reconstruction and virtual endoscopy of airway) on airway management in adult patients undergoing head and neck cancer surgeries under general anaesthesia: Randomised controlled study (3D-ARC Study: 3D Airway Reconstruction for Cancer airway management)

Background and Aims: Traditional airway assessment methods likely miss findings, resulting in unanticipated difficult airways. Surgeons routinely do computed tomography (CT) scans of head and neck cancer patients to determine the extent and resectability of the disease. We used these images for 3-dimensional CT (3D CT) reconstruction to provide additional airway-related information to the anaesthesiologist and studied its impact on airway management. Methods: We randomly allocated 60 patients into two groups to formulate the airway management plan: Group A (Conventional airway assessment) and Group B (Conventional airway assessment along with 3D CT findings). A CT reporting format was prepared based on a literature review after discussion with radiologists and airway experts. In the case of luminal obstruction, a virtual endoscopy video was also created. These findings were shown to the anaesthesiologist managing the airway, and any change in the primary plan was noted. The primary outcome was the total time required for successful airway management. Secondary outcomes included the number of attempts, number of alternative techniques, other manoeuvres required, incidence of failed intubation, and any complications. Data were analysed using the SPSS statistics software. Results: The airway management time between both groups was comparable, with a median difference of 0 [95% confidence interval (CI): −14, 20; P = 0.752]. Among the manoeuvres used, optimal external laryngeal manipulation (OELM) was required more in Group A ( P = 0.007). Both groups had no difference in the number of attempts ( P > 0.99), number of alternative techniques ( P = 0.052), and complications ( P > 0.99). There was a significant change in the endotracheal tube size after CT findings were shown ( P < 0.001). It aided in selecting the preferred side of the nostril for nasotracheal intubation (kappa = 0.545, showing moderate agreement between before and after CT groups). As per the feedback from anaesthesiologists who rated 3D CT on a Likert scale, it was considered beneficial for airway assessment. Conclusion: 3D CT reconstruction and virtual endoscopy can be a valuable method of airway assessment.