Feasibility of ultrasound measurement of tracheal diameter in patients undergoing severe scoliosis orthopedic surgery: A randomized trial

Objective To explore the feasibility of ultrasound measurement of the transverse diameter of the cervical trachea at its narrowest point in patients undergoing severe scoliosis orthopedic surgery. Methods A total of 110 patients, aged 18-65, who scheduled for elective orthopedic surgery for severe scoliosis were included. Prior to surgery, all patients underwent two types of tracheal inner diameter measurements: (1) CT measurement of the anteroposterior diameter (D min,AP ) and transverse diameter (D min,T ) of the cervical trachea at its narrowest point; and (2) ultrasound measurement of D min,T . Based on the measurement results, the patients were randomly divided into two groups, the CT group ( n = 55) and the ultrasound group ( n = 55). We compared the D min,AP and D min,T measured by CT for all patients. Then, we compared CT and ultrasound measurements of D min,T . Furthermore, we conducted an analysis to determine the correlation and consistency between the two methods. Additionally, we examined the success rate of first-attempt tracheal intubation and the occurrence rate of tracheal tube being too wide or too narrow between the two groups, and assessed the occurrence of postoperative 24-h pharyngeal pain and hoarseness. Results When comparing the D min,AP and D min,T measured by CT in all patients, a statistically significant difference was observed ( p < .001). When comparing the measurements of D min,T between CT and ultrasound in all patients, no statistically significant differences were found ( p > .05). The correlation coefficient (r) between CT and ultrasound measurements of D min,T was 0.849 ( p < .001). The mean difference in D min,T was 0.19 mm, and the limits of agreement (LoA) were −2.24 mm to 2.62 mm. Conclusions Ultrasound measurement of D min,T in severe scoliosis patients is feasible and provides valuable guidance for the selection of endotracheal tube sizes. It serves as a non-invasive and bedside auxiliary examination method for perioperative airway assessment.