Neck Circumference Measurement Research Articles

Action protocol of medical staff for airway obstruction after anterior cervical spine surgery: A systematic review of case reports

BackgroundPostoperative airway obstruction after anterior cervical spine surgery (ACSS) can be a fatal complication. Occasionally, it rapidly progresses to complete obstruction. There are no established standardized protocols on how medical staff should assess for signs and symptoms, seek help, or facilitate airway management after ACSS to prevent unfavorable events. This study aimed to primarily describe a systematic approach by assessing the signs and treatment outcomes of airway compromise in patients who underwent ACSS. Further, it recommended an action protocol after extubation for medical staff according to patients’ symptoms to prevent unfavorable outcomes. MethodsAn extensive literature search was performed on PubMed, Web of Science, and the Cochrane Library to identify case reports, case series, and cohort studies restricted to English and published between January 1990 and March 2023. We included cases that described the signs, symptoms, and treatment of airway obstruction after ACSS. Meanwhile, cases involving complications of other known causes, cases of trauma or occipital-cervical fixation, or those using bone morphogenetic protein were excluded. ResultsTwenty cases from 17 studies were obtained, and their study quality was acceptable. Four patients died, and two presented with hypoxic ischemic encephalopathy. Further, five of six patients had fatal complications that initially developed within 7 h after surgery. Then, 9 (69%) of 13 patients with evidence of hematoma (69%) showed initial symptoms within 12 h after surgery. Finally, 9 of 11 patients with early-stage symptoms had favorable outcomes, and patients who developed late-stage symptoms commonly had unfavorable outcomes. ConclusionThe early identification of signs and symptoms and immediate treatment are important, particularly within 12 h postoperatively. We suggest a novel action protocol for medical staff according to symptom urgency, which includes the measurement of neck circumference using a string for evaluating neck swelling.

Neck circumference as an alternative marker of metabolic syndrome in Peruvian adults: A retrospective, cross-sectional study

Neck circumference is a low-cost and simple anthropometric measure that has been proven to accurately assess central obesity. However, evidence of its use and feasibility in low-resource settings is limited. We aimed to compare the utility of neck circumference with standard physical measures of obesity in northern Peru. This was a retrospective, cross-sectional study conducted among adults screened for metabolic syndrome. Body mass index, waist circumference, neck circumference, and additional measurements for metabolic syndrome were obtained. Assessments were performed following the WHO STEPS Surveillance Manual. Pearson correlation coefficients and multiple linear regression models were used to estimate the relationship of neck circumference to waist circumference and body mass index. Data from 250 participants showed a normal, homogeneous distribution in both men and women with respect to age and physical/biochemical measurements. The mean age was 53.6 years. A positive correlation of neck circumference with body mass index (r = 0.51 for women and 0.65 for men) and waist circumference (r = 0.6 for women and 0.74 for men) was observed. Multiple linear regression showed that a 1-cm increase in neck circumference increased body mass index by 0.72 kg/m2 (p < 0.001) in men and 0.94 kg/m2 (p < 0.001) in women, and waist circumference by 2.20 cm (p < 0.001) in men and 2.27 cm (p < 0.001) in women. Our findings suggest that neck circumference is a valid and reliable measure that will replace body mass index and waist circumference in Peruvian adults with central obesity; due to the strong correlation that exists between the NC and these anthropometric measurements, mainly because it is an easy, quick measurement and is less vulnerable to errors such as in the measurement of abdominal circumference or variabilities in weight.

Bedside preoperative predictors of difficult laryngeal exposure in microlaryngeal surgery.

Successful microlaryngeal surgery relies on an adequate laryngeal exposure. Recognizing the likelihood of challenging exposure prior to microlaryngeal surgery may assist in selecting the appropriate surgical approach and even prompt consideration of alternative treatment options. We aim to apply the mini-Laryngoscore, a preoperative assessment tool, to our study population and incorporate novel variables to optimize the prediction model. This single-center prospective cohort study included 80 consecutive patients undergoing elective microlaryngeal surgery, from January 1, to June 30, 2023. Each patient underwent a presurgical evaluation of 15 parameters and an intraoperative scoring of the anterior commissure visualization. These parameters were assessed for their association with difficult laryngeal exposure, using multiple logistic regression analysis. We created a novel prediction model for DLE and compared it with the existing model, the mini-Laryngoscore. Out of 80 patients, 24 (30%) patients had difficult laryngeal exposure, including 3 cases (3.8%) in which visualization of the anterior commissure was not possible. A large neck diameter (OR, 1.4; CI 1.1-1.9) and the presence of upper teeth (OR, 8.9; CI 1.3-62.8) were independent risk factors for a difficult laryngeal exposure, while a larger interincisors gap was the only independent protector factor (OR, 0.3; CI 0.1-0.8). The logistic regression model combining these three independent risk factors displayed a high discriminative value AUC = 0.89 (CI 0.81-0.97). The predictive performance of the mini-Laryngoscore was 0.73 (CI 0.62-0.85). Combining two parameters from the mini-Laryngoscore (upper jaw dental state and interincisors gap distance) with neck circumference measurement can accurately predict the risk of difficult laryngeal exposure.

Clinical Demonstration of the Relationship Between Cervical Subcutaneous Fat Tissue Thickness and Obesity

ABSTRACT Objective Neck pain is an important complaint in neurosurgery practice and is observed with a frequency of 30-50% throughout life. The most common complaint of working women who apply to the doctor is neck pain. Obesity is known as a common disease in recent years and traditional measurements are used in its evaluation in practice. In this research, we aimed to show the relationship between obesity in patients with neck pain that may accompany cervical disc herniation. We examined the usability of neck circumference measurement in indicating obesity. Materials and Methods This study was made on 100 patients aged between 20 and 70, after determining the Sample Size with Power Analysis. The presence of cervical disc herniation and the thickness of the cervical subcutaneous adipose tissue were measured and recorded on Magnetic Resonance Imaging. Neck circumference measurements of the patients were compared with waist circumference measurements. The data collected for the study were recorded using the SPSS 22 program and analysed in the same program. Results 55% of the patients had disc herniation and 38% had an additional chronic disease. Individuals with a cervical herniated disc had higher waist circumference and subcutaneous asymptote tissue values than those without (p&lt;0.01). BMI values of individuals with a cervical herniated disc were found to be higher than those without (respectively, 30.47±4.93, 27.77±4.60, p=0.023). A positive linear correlation was found between the BMI values of the patients, neck circumference, waist circumference and subcutaneous adipose tissue (p&lt;0.05 core coefficient 0.676&amp;0.750&amp;0.463, respectively). Conclusion Neck circumference measurement, which is a simple and fast method, we can diagnose obesity. We saw that in our study, as in many cases, obesity was observed more frequently with cervical disc herniation, especially in women.

СLINICAL CHARACTERISTICS OF CHILDREN AND ADOLESCENTS WITH METABOLIC SYNDROME IN KYIV

This study aimed to clinically evaluate children and adolescents with metabolic syndrome (MetS) in order to identify and diagnose the condition at an early stage and prevent possible complications.&#x0D; Materials and Methods. A comprehensive examination of 105 children aged 10 to 17 years with MetS was conducted at the Rheumatology and Cardiology Department of Children's Clinical Hospital No. 6 in Kyiv. The International Diabetes Federation (IDF) criteria were used to establish MetS. Anthropometric assessments included calculation of body mass index, evaluation of waist circumference using age-specific percentile charts, determination of waist-to-height ratio (WHtR), and measurement of neck circumference in lying and standing positions. Ambulatory blood pressure monitoring was performed using the ABM-04 device (Meditech, Hungary), and laboratory investigations (glucose, insulin, lipid profile) were conducted using the Cobas 6000 analyzer and test system (Roche Diagnostics). The EZR version 1.61 (November 11, 2022) package was used for statistical analysis of the obtained data.&#x0D; Results and Discussion. In terms of heredity analysis, the presence of hypertension in the father of children, maternal grandmother, and mother was the most common, indicating the importance of genetic influence on the development of this condition. Among the most common complaints were elevated blood pressure, headaches, anxiety, and palpitations. The logistic regression model demonstrated that daytime sleepiness was associated with symptoms such as sweating, morning hoarseness, tinnitus, weather sensitivity, and fatigue. There was no statistically significant difference between the manifestations of acanthosis nigricans and purple stretch marks in girls and boys, but a higher tendency was observed in males.&#x0D; Conclusions. Metabolic syndrome in children and adolescents is associated with a high risk of complications, as most of them have a high WHtR value. Cardiovascular diseases showed the highest hereditary dependency in close relatives of children with MetS. Cardiovascular symptoms are the most common among children with MetS, but girls had significantly higher frequencies of emotional and psychological symptoms.

The Impact of Clinical and Craniofacial Changes on the Surgical Outcomes of Lateral Pharyngoplasty in the Treatment of Obstructive Sleep Apnea.

Objective To verify if maxillomandibular retrusion, obesity, and increased neck circumference are factors of worse surgical prognosis for lateral pharyngoplasty in apneic patients. Materials and Methods We evaluated 53 patients with obstructive sleep apnea who underwent lateral pharyngoplasty. Clinical evaluation was performed before the surgical procedure and included the measurement of body mass index (BMI) in kg/m 2 , neck circumference in centimeters, and a clinical evaluation of the facial profile obtained through the natural position of the oriented head. The polysomnographic evaluation was performed with at a minimum of 6 months after surgery, and polysomnographic results were correlated with the preoperative clinical data. Results The mean age of the patients was 38.8 years; the mean BMI was of 29.28kg/m 2 , and 84.9% of the sample was composed of men and 15.1% of women. There was a significant reduction in the mean value of the main respiratory parameters verified by polysomnography, such as apnea-hypopnea index (AHI) from 31.60 events per hour to 8.15 ( p < 0.001); NadirO 2 went from 81% to 85% ( p = 0.002) and mean oxyhemoglobin saturation from 94% to 95% ( p = 0.024). It was also observed that the greater the maxillomandibular retrusion, the lower the mean reduction of the AHI after surgery. The increase in neck circumference proved to be a factor associated with the surgical outcome, and for each 1-cm decrease in the neck circumference, the chance of surgical success increased 1.2-fold. Conclusion Lateral pharyngoplasty is an efficient surgical obstructive sleep apnea treatment. The lower the neck circumference measurement, the greater the chances of surgical success, and clinically evaluated maxillomandibular retrusion can reduce the magnitude of improvement in respiratory parameters after lateral pharyngoplasty in apneic patients.

Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature

PurposeTo prospectively assess the incidence of Dropped Head Syndrome (DHS) in childhood cancer survivors (CCS) and to develop and evaluate a diagnostic algorithm for DHS.MethodsA systematic literature search for DHS in combination with neck radiotherapy (RT) exposure was performed. Analyses and a combination of the most common examination methods were integrated into a diagnostic algorithm. Almost all CCSs visiting the local late effects clinic between May 2020 and April 2022 were included in the study. CCS exposed to neck RT with doses ≥ 19 Gy received standardized clinical and neurological assessment and, in case of abnormal results, an MRI scan to confirm muscle atrophy.ResultsTwo hundred and five CCS were included of whom 41 received RT to the neck with ≥ 19 Gy. In the entire cohort and in the subgroup receiving RT, 2.4% and 12% of CCS were affected by DHS, respectively. Results of clinical and neurological assessment correlated well with MRI results. Neck circumference and neck/thigh ratio were lower after neck RT. Over 50% of CCS experienced neck disability and pain.ConclusionsA relevant proportion of CCS exposed to neck RT is affected by DHS. High concordance of MRI results with the neurological examination supports the clinical value of the diagnostic algorithm. Measurement of neck circumference might be an easy tool for assessment of neck muscle atrophy in survivors at risk.Implications for cancer survivorsIntegration of a diagnostic algorithm for DHS in standard long-term follow-up care facilitates diagnosis as well as initiation of early treatment and obviates the need for invasive examinations.

Understanding the Association Between Obesity and Obstructive Sleep Apnea Syndrome: A Case-Control Study.

Introduction Obstructive sleep apnea (OSA) represents a sleep-related impairment linked to upper airway function. The question of whether OSA drives obesity or if shared underlying factors contribute to both conditions remains unresolved. Hence, this present study aims to understand the interplay between obstructive sleep apnea syndrome (OSAS) and obesity through in-depth analysis of anthropometric data within control subjects and OSA patients. Methodology A case-control study was conducted, which included 40 cases and 40 matched healthy controls. Study participants with reported symptoms of snoring, daytime drowsiness, or both were included in the study. All the study participants underwent comprehensive anthropometric assessments such as height, weight, body mass index (BMI), neck circumference, waist circumference, hip circumference, waist-to-hip ratio, skin-fold thickness, and thickness measurements of biceps, triceps, suprailiac, and subscapular muscles. Results Within the OSA group, significant disparities emerged in mean age, waist circumference, waist-to-hip ratio, and diverse fat accumulations encompassing visceral, subcutaneous, trunk, and subcutaneous leg fat. Notably, skin-fold thickness at specific sites - biceps, triceps, subscapula, and suprailiac - demonstrated considerable augmentation relative to the control group. Furthermore, mean values associated with height, weight, BMI, neck circumference, fat percentage, subcutaneous arm fat, entire arm composition, and trunk skeletal muscle either equaled or exceeded those in the control group. However, statistical significance was not attained in these comparisons. Conclusion This investigation underscored a pronounced correlation between numerous endpoints characterizing OSA patients and markers of obesity. Consequently, addressing altered levels of obesity-linked anthropometric variables through pharmacological interventions might hold promise as a pivotal strategy for improving symptoms associated with OSA.

Obstructive Sleep Apnea and a Comprehensive Remotely Supervised Rehabilitation Program: Protocol for a Randomized Controlled Trial.

Obstructive sleep apnea (OSA) is characterized by recurrent, intermittent partial or complete obstruction of the upper respiratory tract during sleep, which negatively affects the patient's daily quality of life (QoL). Middle-aged and older men who smoke and have obesity are most at risk. Even though the use of continuous positive airway pressure (CPAP) during sleep remains the gold standard treatment, various rehabilitation methods, such as exercise, respiratory therapy, myofunctional therapy, and nutritional lifestyle interventions, also appear to be effective. Moreover, it is increasingly recommended to use alternative or additional therapy options in combination with CPAP therapy. This study aims to evaluate if a comprehensive home-based, remotely supervised rehabilitation program (tele-RHB), in combination with standard therapy, can improve OSA severity by decreasing the apnea-hypopnea index (AHI); improve objective parameters of polysomnographic, spirometric, anthropometric, and body composition examinations; improve lipid profile, maximal mouth pressure, and functional capacity tests; and enhance the subjective perception of QoL, as well as daytime sleepiness in male participants with moderate to severe OSA. Our hypothesis is that a combination of the tele-RHB program and CPAP therapy will be more effective by improving OSA severity and the abovementioned parameters. This randomized controlled trial aims to recruit 50 male participants between the ages of 30 and 60 years with newly diagnosed moderate to severe OSA. Participants will be randomized 1:1, either to a 12-week tele-RHB program along with CPAP therapy or to CPAP therapy alone. After the completion of the intervention, the participants will be invited to complete a 1-year follow-up. The primary outcomes will be the polysomnographic value of AHI, Epworth Sleepiness Scale score, 36-Item Short Form Health Survey (SF-36) score, percentage of body fat, 6-minute walk test distance covered, as well as maximal inspiratory and expiratory mouth pressure values. Secondary outcomes will include polysomnographic values of oxygen desaturation index, supine AHI, total sleep time, average heart rate, mean oxygen saturation, and the percentage of time with oxygen saturation below 90%; anthropometric measurements of neck, waist, and hip circumference; BMI values; forced vital capacity; forced expiratory volume in 1 second; World Health Organization's tool to measure QoL (WHOQOL-BREF) score; and lipid profile values. Study recruitment began on October 25, 2021, and the estimated study completion date is December 2024. Analyses will be performed to examine whether the combination of the tele-RHB program and CPAP therapy will be more effective in the reduction of OSA severity and improvement of QoL, body composition and circumferences, exercise tolerance, lipid profile, as well as respiratory muscle and lung function, compared to CPAP therapy alone. The study will evaluate the effect of a comprehensive tele-RHB program on selected parameters mentioned above in male participants. The results of this intervention could help the further development of novel additional therapeutic home-based options for OSA. ClinicalTrials.gov NCT04759456; https://clinicaltrials.gov/ct2/show/NCT04759456. DERR1-10.2196/47460.

Overweight and obesity screening indicator using neck circumference

Background: Overweight and obesity can be assessed through anthropometric measurements using the body mass index (BMI). Some studies suggest that neck fat is positively correlated with visceral fat, insulin resistance, and metabolic syndrome. Neck circumference has been shown to be closely correlated with BMI and can be used as a practical screening tool for identifying overweight or obese individuals in both men and women. However, the correlation of neck circumference with measurements of body fat percentage in obesity has not been studied. Methods: This study is an analytical study that conducted sensitivity and specificity analyses of neck circumference to describe indicators of overweight and obesity in children. Data collected included neck circumference, weight, height (converted into BMI), and other characteristics of the children. Neck circumference measurements were taken using neck circumference tape. Results: The results showed that the body weight of school-age children had an average of 28.3 kg. Height had an average of 133.2 cm. Neck circumference measurements had an average of 30.3 cm. The correlation analysis using the Pearson product moment test showed a significant value of r=0.483 and p=0.00. Conclusions: There is a significant relationship between neck circumference and BMI. The greater the neck circumference, the greater the BMI, and the area under the curve (AUC) of the ROC curve indicates that neck circumference is a better diagnostic tool for identifying BMI. The results of the ROC curve showed a UAC value of 0.783, indicating that neck circumference can diagnose obesity with an accuracy of 78.3%.

Test-Retest Reliability of Local Tissue Water and Circumference Measurements in the Head and Neck Area of Healthy Women and Men.

Background: Measurements of local tissue water and circumferences are methods to evaluate lymphedema. Knowledge about reference values and reproducibility needs, however, to be determined for the head and neck (HN) area of healthy persons before it can be used in persons with HN lymphedema. The objective of this study was to evaluate the test-retest reliability including measurement errors of local tissue water and neck circumference measurements (CM) in the HN area in a healthy cohort. Methods and Results: Thirty-one women and 29 men were measured on 2 occasions, 14 days apart. The percentage of tissue water content (PWC) were calculated in four facial points and neck CM at three levels. Intraclass correlation coefficient (ICC), changes in mean, standard error of measurement (SEM%), and smallest real difference (SRD%) were calculated. Reliability for PWC was fair to excellent for both women (ICC 0.67-0.89) and men (ICC 0.71-0.87). Measurement errors were acceptable in all points in both women (SEM% 3.6%-6.4%, SRD% 9.9%-17.7%) and men (SEM% 5.1%-10.9%, SRD% 14.2%-30.3%). For the CM, ICCs were excellent both for women (ICC 0.85-0.90) and men (ICC 0.92-0.94), and measurement errors were low (SEM% for women 1.9%-2.1%, SRD% 5.1%-5.9%; SEM% for men 1.6%-2.0%, SRD% 4.6%-5.6%). Most of the lowest values were found close to bone and vessels. Conclusion: Measurements for PWC and CM in the HN area are reliable in healthy women and men, with acceptable to low measurement errors. PWC points close to bony structures and vessels should, however, be used with caution.

Hypogonadism in men with obstructive sleep apnea and its related risk factors

Background Sleep-related breathing disorders, including obstructive sleep apnea (OSA), have been linked to altered hypothalamic–pituitary–gonadal axis. Hypoxia, sleep fragmentation. and decreased deep sleep time in patients with OSA affect the hypothalamic–pituitary–gonadal axis, including serum luteinizing hormone (LH) and testosterone levels.Purpose To study serum levels of LH and testosterone in men with OSA and to investigate the possible risk factors that could affect their levels.Patients and methods This was a prospective cohort case–control study. The case group included 16 adult patients diagnosed with OSA confirmed by polysomnography. The control group included 16 matched healthy participants. Both groups were subjected to history taking, clinical examination, and investigations, including the Epworth sleepiness scale, BMI, neck circumference measurement, and serum levels of LH and testosterone.Results Patients with OSA had significantly higher mean levels of serum LH compared with healthy controls (P=0.031). The mean serum level of testosterone was lower in the OSA group compared with the matched controls; however, this difference was statistically insignificant (P=0.192). Among the studied risk factors for altered hormonal levels in patients with OSA, there was a significant positive correlation between desaturation index and serum LH levels (P=0.046) and a significant negative correlation between Epworth sleepiness scale and serum testosterone levels (P=0.025).Conclusion Our findings suggest that OSA in men is associated with a dysfunction in the hypothalamic–pituitary–gonadal axis, represented as high levels of serum LH. Although serum levels of testosterone were lower in patients with OSA, the study was underpowered to show a statistically significant difference.

Predicting Difficult Laryngoscopy by Ultrasound Quantification of Anterior Neck Soft Tissue Thickness-A Prospective Observational Study

Introduction: Difficult airway can possess a challenge to intubation and deciding role in morbidity and mortality. Hence, at these times Ultrasonography (USG) can play a vital role in the prediction of a difficult airway. Aim: To determine if USG measurement of anterior neck soft tissue thickness at the hyoid bone, and anterior commissure levels can be used to predict difficult laryngoscopy. Materials and Methods: The prospective observational study was carried out from January 2021-January 2022. There were 50 patients, aged 20-60 years, and scheduled to undergo general anaesthesia. Correlation analysis between roles of screening tests like Mallampati scoring (MMP), Cormack Lehane (CL) grade Neck Circumference (NC), Thyromental Distance (TMD) and USG measurements was done for predicting difficult laryngoscopy. Portable USG machine with a linear frequency probe, measuring tape and laryngoscope blade was required. The data was analysed using Statistical Package for Social Sciences (SPSS) version 22. Results: The incidence of difficult laryngoscopy was 18% and the mean age of the study participants in the easy group was 44.26 years and in the difficult group it was 45.13 years. The USG measurements were significant (p-value=0.01) in determining difficult intubation, which shows greater validity to predict difficult laryngoscopy. Hence, USG measurement along with bedside screening test aids in better identification and assessment of difficult airway. Conclusion: Anterior neck soft tissue thickness measured by USG at the hyoid bone, and anterior commissure levels combined with the screening tests and risk factors might increase the ability to predict difficult airways.

Neck Circumference and Blood Pressure Measurements among Walter Sisulu University Students.

Hypertension is a public health problem in South Africa. Increases in subcutaneous fat, presented by the neck circumference (NC) value, contribute to and predict the development of hypertension. However, to date, there has been no study done to investigate the relationship between the NC and blood pressure (BP) among historically disadvantaged university students. Therefore, the aim of the study was to investigate the relationship between the NC and BP among Walter Sisulu University students. This cross-sectional study was conducted in Walter Sisulu University. All 127 students were aged 18 years and above and underwent NC and clinical BP measurements using standard procedures. In a Pearson's correlation analysis, the NC positively correlated with both the systolic blood pressure (SBP) (r = 0.5; p &lt; 0.001) and diastolic blood pressure (DBP) (r = 0.3; p &lt; 0.001). Furthermore, in the multivariable-adjusted regression analysis, the NC was positively associated with both the SBP (adjusted R2 = 0.3, β = 2.0 (95% CI = 1.1; 2.9), p &lt; 0.001) and DBP (adjusted R2 = 0.1 β = 0.950 (95% CI = 0.3; 1.6), p = 0.008) adjusted for age, gender, body mass index, waist-to-height ratio, alcohol, and smoking. The NC is related to BP among historically disadvantaged university students.

Measurement of Neck Circumference, Tongue thickness and Skin to Epiglottis Distance as Predictors of Difficult Intubation: A Prospective Study

Airway Assessment is essential in pre anesthetic assessment. Anticipating and preparing for difficulty in airway management is crucial to avoid airway catastrophes. Routine pre operative airway examination usually includes mouth opening and dentition, Mallampati classification, thyromental distance and neck movements. Neck circumference is a quick bedside test to determine difficult laryngoscopy. Increased tongue thickness and skin to epiglottis distance affects performance of laryngoscopy and tracheal intubation increasing the risk of difficult airway. Presently there is a search for non-invasive and accurate tools to overcome limitations of clinical airway assessment tests. Ultrasonography has been evolving as a useful device for airway assessment especially soft tissue structures in anterior surface of neck. Here we studied the measurement of neck circumference and ultrasound measurement of tonguethickness and skin to epiglottis distance as predictors for difficult intubation. The Aim of the study is to predict difficulty in intubation by measuring neck circumference, thickness of tongue and thickness of skin to epiglottis. Prospective observational study, 120 patients posted for surgery under general anesthesia, Department of anesthesia, Meenakshi medical college, Kanchipuram. After institutional Human ethical committee clearance, 120 Patients were screened during preoperative assessment for undergoing procedures under general anaesthesia. Neck circumference and other airway parameters were measured with measuring tape and distance between Skin to epiglottis and tongue thickness were measured with ultrasound linear probe. Patients were grouped into Group E( Easy Intubation) whose Cormack-lehane grade was 1 and 2 and Group D ( Difficult intubation) whose Cormack-lehane grade was 3 and 4. SPSS version 16 was used for statistical analysis. There was no statistical significance seen between age, sex, height among easy and difficult intubation but significance was seen with weight (p &lt;0.05), Thyromental distance(p&lt;0.05) and Sterno-mental distance(p&lt;0.05). High significance was seen in Distance between skin to epiglottis distance(p&lt;0.001), Tongue thickness(p&lt;0.001) and Neck Circumference(p&lt;0.001) in difficult intubation cases. Neck circumference and ultrasonographic measurement of tongue thickness and skin to epiglottis can avoid unanticipated difficult intubation.

Is Neck Circumference Related to Other Anthropometric Measurements and Biochemical Parameters in Type 2 Diabetes?

Background Obesity is one of the leading risk factors for developing type 2 diabetes mellitus (T2DM). Body mass index (BMI), waist circumference, and waist/hip ratio are anthropometric measurements used to diagnose obesity. In recent years, neck circumference, one of the anthropometric indicators used in assessing obesity, has come to the fore. This study investigates the relationship between neck circumference and other anthropometric measurements and specific biochemical parameters in T2DM. Methods Four hundred sixty-four individuals with type 2 diabetes were included in the study. Subjects' body weight, height, and other anthropometric measurements like circumferences of the waist, hip, and neck were measured. BMI, waist/hip, and waist/height ratio were calculated. The biochemical tests of the subjects in the previous month from the study were accessed from the hospital information system. The relationship between anthropometric measurements and biochemical parameters with neck circumference was evaluated. Results The mean age of the subjects was 54.6±8.51 years. 56.2% were femaleand 43.8% were male, and the time from T2DM diagnosis was 9.9±7.49 years. Most male subjects were overweight (49.8%), and approximately one-third of the women were first-degree obese (33.0%). Body weight, BMI, waist, hip, and neck circumferences, and waist/hip and waist/height ratios were significantly higher in both male and female subjects in the neck circumference high-risk group than those in the low-risk group (p<0.05). In terms of biochemical parameters, fasting blood glucose andHbA1c values of men with neck circumference at risk were significantly higher than those in the low-risk group. Neck circumference measurements of the participants were positively correlated with body weight (r=0.543; p<0.001), height (r=0.260; p<0.001), waist circumference (r=0.562; p<0.001), hip circumference (r=0.293; p<0.001), BMI (r=0.366; p<0.001), waist/hip ratio (r=0.428, p<0.001), and waist/height ratio (r=0.393, p<0.001). Neck circumference had a low positivecorrelation with fasting blood glucose (r=0.165; p<0.001), HbA1c (r=0.281; p<0.001), and triglyceride (r=0.231; p<0.001) and a negative relationship with low-density lipoprotein cholesterol (r=-0.118; p=0.001). When the relationship between neck circumference and biochemical parameters was examined, it was seen that this correlation was only in men. Conclusion Neck circumference measurement is a simple and reliable method andis not affected by external factors. It correlates with other anthropometric measurements and can be used as a good indicator of the distribution of upper subcutaneous adipose tissue in T2DM. However, more studies with larger samples are needed on this subject.

Neck Circumference Measurement for Surveillance and Early Detection of Hemorrhage After Thyroidectomy

Postthyroidectomy hemorrhage is a potentially life-threatening complication with no reliable noninvasive method of early detection. To evaluate the diagnostic accuracy of neck circumference measurement for early detection of postoperative hemorrhage after thyroidectomy. This diagnostic accuracy study at an academic teaching hospital used a prospective cohort of patients undergoing thyroid surgery from November 1, 2015, to January 31, 2018 (group 1), and a retrospective cohort of patients undergoing the same surgery from January 1, 2020, to September 30, 2021 (group 2). We performed repeated perioperative neck circumference measurements to evaluate the association of increased neck circumference with postthyroidectomy hemorrhage among patients at risk for hemorrhage. The primary end point was the diagnostic value of neck circumference measurement for detection of postthyroidectomy hemorrhage. Additionally, data on demographic information and risk factors for postthyroidectomy hemorrhage were examined. Data analyses were performed from November 1, 2021, to January 5, 2022. The prospective cohort (group 1) comprised 60 patients (45 [75%] women) with a mean (SD) age of 52.2 (13.5) years; those who experienced a postthyroidectomy hemorrhage had a mean (SD) age of 57.4 (9.0) years. The retrospective cohort (group 2) comprised 353 patients (258 [73%] women) with a mean (SD) age of 55.3 (14.1) years; patients who experienced a postthyroidectomy hemorrhage had a mean (SD) age of 62.2 (10.0) years. In group 1, postoperative neck circumference increased by a median (range) of 5.0 (4.0 to 7.0) cm in patients with hemorrhage, and only 1.0 (-2.5 to 4.0) cm in patients with no postoperative bleeding (difference in the medians, 4.0 cm [95% CI, 3.0 to 5.5 cm]; effect size, 3.74 [95% CI, 2.6 to 4.9]). Defining a 7% or greater increase in neck circumference as the cutoff value for detecting postthyroidectomy hemorrhage showed a diagnostic sensitivity and specificity of 1.0 (95% CI, 0.48 to 1.0) and 0.86 (95% CI, 0.71 to 0.92), respectively. The retrospective validation also showed a difference in median (range) increase of postoperative neck circumference between patients with hemorrhage and those without-3.0 (0 to 6.0) cm vs 0.0 (-6.0 to 5.0) cm (difference in medians, 3.8 cm [95% CI, 3.0 to 4.9]; effect size, 1.63 [95% CI, 0.96 to 2.3]). Considering 12 false-positive and 332 correct-negative results, the diagnostic tool showed a sensitivity of 0.89 (95% CI, 0.51 to 0.99) and a specificity of 0.97 (95% CI, 0.94 to 0.98). The findings of this diagnostic accuracy study suggest that neck circumference measurement is a feasible and easy-to-use diagnostic tool for routine clinical care to detect postthyroidectomy hemorrhage. A 7% or greater increase over the postoperative baseline neck circumference seems to be a reliable threshold for detecting postthyroidectomy hemorrhage. Neck circumference measurement should be used in combination with surveillance of clinical signs and symptoms.

Significance of Ratio of the Neck Circumference and Thyromental Distance as a Predictor of Difficult Intubation in Obese Patients

Objective: To ascertain the diagnostic accuracy of raised neck circumference to thyromental distance ratio (NC/TMD) for difficulty in intubation among patients with obesity keeping grades III and IV of Cormack and Lehane's score as the gold standard.&#x0D; Study Design: Cross-sectional validation study.&#x0D; Place and Duration of Study: Anesthesiology Department, Combined Military Hospital Rawalpindi, from Jul to Dec 2017.&#x0D; Methodology: One hundred and thirty obese patients who had to undergo surgery under general anaesthesia were included in the study. All the patients underwent measurement of neck circumference to thyromental distance ratio, and raised neck circumference to thyromental distance ratio was noted. Difficult intubation was labelled according to the grades III and IV of Cormack and Lehane's score.&#x0D; Results: In this study, 130 cases were included. Fifty-eight patients were males, and 72 were females. Diagnostic accuracy of raised neck circumference to thyromental distance ratio for difficulty in intubation among patients who were obese, was recorded where sensitivity was 83.87%, and specificity was found to be 91.92%, positive predictive value as 76.47%, negative predictive value as 94.79%, the accuracy rate was calculated as 90%.&#x0D; Conclusion: Our study showed that difficulty in intubation is more frequent in patients who are obese and the neck circumference to thyromental distance ratio is a reliable method for foreseeing difficult intubation compared to other established predictors with cut off value of 5.0.

0781 Neck circumference: A surrogate predictive variable of hypoglossal nerve stimulator therapy outcome

Abstract Introduction Hypoglossal nerve stimulation therapy has strict eligibility requirements including a body mass index &amp;lt; 32kg/m2 for non-Medicare patients and body mass index &amp;lt; 35kg/m2 for Medicare patients. However, there is a wide variability in body fat distribution including variability between the sexes. We theorize that neck circumference may be a better surrogate predictive variable for hypoglossal nerve stimulation outcomes than body mass index. Methods A retrospective chart review was conducted at a single tertiary care center on adults who underwent hypoglossal nerve stimulator implantation by a single surgeon from March 2017 to October 2021. Baseline demographic data including neck circumference, diagnostic polysomnography and post-implantation polysomnography titration studies were collected. Patients without neck circumference measurements were excluded. Surgical success was defined by Sher criteria of apnea hypopnea index &amp;lt; 20 and reduction of the apnea hypopnea index by 50%. Results 75 patient charts were reviewed. 44 of these patients had neck circumference, body mass index, and AHI at effective voltage (AHI-v) data recorded. These were included in the analysis. Overall, AHI-v positively correlated with neck circumference (r2=0.20, p= 0.0025). Conversely, no significant association was apparent between AHI-v and BMI (r2=0.04, p=0.18). AHI-v appeared to worsen at a specific neck circumference of &amp;gt; 15 inches. T-test analysis showed significant difference in AHI-v comparing the groups of neck circumference ≤15in. vs &amp;gt; 15in. (x̄=27.58 vs 7.68, respectively, p=&amp;lt;0.001). However, no significant difference was found in mean BMI, age or baseline AHI between the neck circumference groups (p=0.15, 0.26, 0.10, respectively). Conclusion Findings suggest that neck circumference correlates to AHI at effective voltage during the post-implantation titration study. Our data indicates that neck circumference may be a better outcome predictor than BMI, baseline AHI or age for hypoglossal nerve stimulator effectiveness. Support (If Any)

Validity Analysis of Neck Circumference as a Screening Test for Hypoxia Occurrence in Patients Undergoing Sedative Endoscopy.

This study was performed to check the validity of and propose a cutoff point for measuring the neck circumference for screening hypoxia occurrence in patients undergoing sedative endoscopy. Data were collected from 168 patients who visited the Endoscopy Center of G University Hospital between 27 April 2020 and 12 June 2020 to undergo sedative endoscopy. Hypoxia occurrences were measured using sleep questionnaires (STOP-BANG and Berlin questionnaires), and the neck circumference measurements of the patients were compared. Neck circumference as a predictor of hypoxia and its sensitivity and specificity according to the cutoff values were high; thus, it is a valid screening test for hypoxia in patients undergoing sedative endoscopy. The most appropriate cutoff values for sitting neck circumference and lying neck circumference in men were 40.5 and 40.3, respectively, and those for women were 35.3 and 35.8, respectively. Hypoxia can be predicted in patients undergoing sedative endoscopy by measuring their neck circumference.