Prediction of Difficult Mask Ventilation in Obese Population Undergoing Emergency Surgery

The current study is an observational, prospective study. It will be conducted in the emergency operative theatre, Alfayoum University, Alfayoum, Egypt. Identification of difficult mask ventilation among obese population is crucial specially in emergency settings with high risk of aspiration pneumonia or hypoxemia. No clinical predicrors were identified up till now. While the patient lies supine with the head in neutral position, Ultrasound guided (high frequency- depth adjusted at 3-4 cm) will be placed in the in submental region to measure the distance between skin to hyoid bone . Hyoid bone will be identified as a hyperechoic shadow below the mentum. Three measures will be taken and the average will be calculated. All candidates will sign informed consent pre-scanning and retain their right to withdraw at any time without compromising their medical care. Exclusion criteria will include elective operations, patient refual, previous neck surgery, prescence of surgical emphysema, emergency cesarean section and submental abcess.

Inclusion Criteria: * Adults aged ≥18 years. Body mass index (BMI) ≥30 kg/m², measured before induction. Patients scheduled for emergency surgical procedures under general anesthesia with planned tracheal intubation. Emergency surgery defined as surgery requiring operative intervention within 24 hours of the decision to operate because postponement may adversely affect the patient. . Availability of sufficient pre-induction time to perform the standardized ultrasound assessment without delaying clinically indicated surgery. Written informed consent obtained from the patient or, where applicable under the approved emergency research procedure, from an authorized representative Exclusion Criteria: * Elective procedures * Patient refusal * Previous anterior neck surgery or radiotherapy with scarring precluding good acoustic window. * Submental trauma, abcess or surgical emphysema. * Planned awake fibrooptic intubation * Planned regional anesthesia * Inability to obtain a technically adequate ultrasound image after standardized attempts. * Emergency C.S * Severe hypoxemia requiring immediate assisted ventilation. Patients already receiving bag-mask ventilation, or invasive ventilation before the ultrasound assessment. \-