Difficult Airway Prediction is an important part of pre anaesthesia assessment as it facilitates planning and preparing to manage a difficult airway. This in turn will enable a smooth perioperative course and reduced perioperative morbidity. Conventional physical assessment for difficult airway can sometimes fail to identify a difficult airway. This has made Point of Care Ultrasonography (POCUS) as an evolving tool for airway assessment.

In this study, both Male and Female Patients above 18yrs of Age, Classified as per American Society of Anaesthesiologist as ASA1,ASA 2, posted for Elective Surgeries planned under General Anaesthesia using endotracheal intubation are included. Pregnant women, Patients with known airway (Oral, pharyngeal, Laryngeal) pathologies, Cervical Vertebral diseases, Large Thyroid and Parathyroid Swelling, Submandibular Salivary Gland Pathology, Healed Post Tracheostomy scar, Post Burn Contractures of Neck, or any scar over the neck and patients posted for Oro-Pharyngeo-Laryngeal procedures and Emergency surgeries are excluded from this study.

In this study, after consent for the study, the airway physical assessment using SARI scoring is evaluated preoperatively. Preoperatively (before Intubation) On the day of Surgery, in the operating room, the primary investigator or  co-investigator shall measure Distance from Skin to Epiglottis (DSE)and Hyomental Distance (HMD)  with neck neutral, extended and in ramped positions ,and tongue thickness (TT) using ultrasound, thus completing the tests in the DARES protocol. It is planned that 15% of Sample size  done by the Primary Investigator shall be validated by Radiologist – Co Investigator. . If the Primary investigator’s assessment is not comparable to Radiologist - Co Investigator, then patients assessed by Primary investigator prior shall be dropped and the Primary Investigator shall be undergoing further training with the co – investigator. Post Training Primary Investigator will continue the study.

The Senior Anaesthesiologist posted on the elective list who is not aware of  the recorded SARI score and DARES protocol measurements will intubate the patient and record the IDS score obtained.

POCUS predictive value in Difficult Airway Assessment using the DARES protocol, will be calculated and compared with conventional physical airway assessment using the SARI score The difficulty of  airway management will be calculated based on the IDS score.