Radiological evaluation of airway – What an anaesthesiologist needs to know!

Airway management forms the foundation of any anaesthetic management. As anesthesia developed, techniques to manage the airway in a more secure manner grew along. However, unanticipated difficult airway (DA) and its sequelae continue to haunt any anesthesiologist. In spite of the development of various clinical parameters to judge difficult airway, none has proved to be accurate in predicting it. Anaesthesiologist should be well aware of its applications for easing prediction of DA with the help of radiologist. The article attempts to provide an exhaustive overview on radiological parameters of airway pertaining to different modalities which can be utilized by anesthesiologists.

1. Roentgenograms, the fast and economic modality, can be used for prediction of DA, estimating endotracheal tube (ET) sizes, depth of insertion, detection of airway tumors, mass effects over airway and assessing airway pathologies in paediatric patients.


2. CT scan reveals finer airway details and can be used for prediction of DA, characterization, and impact of airway lesions not diagnosed on X-ray, eg., tracheobronchomalacia, Saber-sheath trachea, etc..


3. CT bronchography and virtual bronchoscopy are comparable to real bronchoscopy with unique applications.


4. MRI, even though not routinely employed, finds use in airway management in unique conditions like hypermobile epiglottis, cervical pathologies, etc.


5. Ultrasonography is rapidly gaining grounds for real-time airway management.


6. 3D printing is a revolutionary technology for educational, research and planning purposes.

The article emphasizes on increasing the use of imaging done for other purposes, namely, diagnosis and surgical planning, etc. to formulate effective airway management plans and also effective communication between anaesthesiologist, treating doctor and the radiologist for better patient management.

The article was jointly contributed by Dr Kinshuki Jain, Senior resident, M.D., Department of Oncoanaesthesia and Palliative Medicine, Dr BRAIRCH AIIMS, New Delhi, Dr Nishkarsh Gupta, Associate Professor, M.D., Department of Oncoanaesthesia and Palliative Medicine, Dr Mukesh Yadav, Assistant Professor, M.D., Department of Radiology, Dr Sanjay Thulkar, Professor and Head of the department, M.D., Department of Radiology and Dr Sushma Bhatnagar Professor and Head of the department, M.D., Department of Oncoanaesthesia and Palliative Medicine, Dr BRAIRCH AIIMS, New Delhi, India, corresponding author of the paper.

The article was published in the Indian Journal of Anesthesia. To know more about the article please click on the link

Jain K, Gupta N, Yadav M, Thulkar S, Bhatnagar S. Radiological evaluation of airway – What an anaesthesiologist needs to know!. Indian J Anaesth [serial online] 2019 [cited 2019 Apr 18];63:257-64. Available from: http://www.ijaweb.org/text.asp?2019/63/4/257/255451