Comparison of different assessment methods in the management of difficult airway: El Ganzouri risk index (EGRI), Intubation difficulty scale (EZS), Wilson classification and ultrasonography measurements

Aims: The aim of this study was to compare different assessment methods and evaluate their efficacy in predicting difficult airway. Materials and Methods: A total of 154 patients (99 females, 55 males) undergoing elective surgery under general anesthesia were included. Physical characteristics (age, body weight, height, BMI, IIG, TMM, gender), clinical scoring systems (MMS, UDIT, EGRI) and ultrasonographic parameters (CHM, CEM, CVKM, CTIM, CSSSM, tongue thickness and tongue volume) were recorded. Laryngoscopy and intubation difficulty were graded by Wilson classification and EZS. Translated with DeepL.com (free version)Results: The incidence of difficult intubation was 11.04% and difficult laryngoscopy was 10.39%. Male gender, age, body weight, MMS, UDIT, EGRI, IIG, TMM, CHM, CEM, CVKM, CTIM, CSSSM, tongue thickness and tongue volume were significantly associated with difficult intubation. The risk of difficult intubation increased 24.6-fold in patients with EGRI ≥4 (sensitivity: 76.5%, specificity: 88.3%). Tongue thickness ≥3.97 cm (sensitivity: 76.5%, specificity: 88.3%, AUC: 0.870) and tongue volume ≥87.750 cm³ (sensitivity: 70.6%, specificity: 81%, AUC: 0.798) had high diagnostic performance. Gender, MMS, UDIT, EGRI, IIG, CEM, tongue thickness and tongue volume parameters showed significance in difficult laryngoscopy. Those with EGRI ≥4 had a 33-fold increased risk of difficult laryngoscopy. Strong predictors were tongue thickness ≥3.745 cm (sensitivity: 93.8%, specificity: 79.7%, AUC:0.896) and tongue volume ≥90.650 cm³ (sensitivity: 81.3%, specificity: 85.5%, AUC:0.880). Conclusion: We recommend the use of EGRI and ultrasonographic measurements of tongue volume and tongue thickness to predict difficult airway in anesthesiology practice. Keywords: Difficult airway, El Ganzouri risk index, Tongue measurements, Intubation difficulty scale