This study focuses on predicting difficult airway during general anesthesia, which is an important concern for patient safety. Difficulty in visualizing the vocal cords during laryngoscopy can lead to serious complications such as low oxygen levels airway trauma and even life threatening situations. Therefore accurate preoperative airway assessment is essential.

Traditionally the Modified Mallampati score is used to assess airway difficulty by examining mouth opening and visibility of oral structures. However this method is subjective and its accuracy is variable. Recent advances in ultrasound technology have made it possible to assess airway anatomy in a simple non invasive and real time manner. One such ultrasound parameter is the skin to epiglottis distance which measures the depth of airway structures and may help predict difficult laryngoscopy more reliably.

This prospective observational study will be conducted at AIIMS Kalyani over a period of six months. Adult patients aged 18 to 65 years belonging to ASA physical status I or II and scheduled for elective surgery under general anesthesia will be included after informed consent. Patients with known airway problems emergency surgeries pregnant patients or cervical spine instability will be excluded.

Before surgery all patients will undergo routine airway assessment using the Modified Mallampati score. Ultrasound examination of the airway will then be performed in the supine position to measure the skin to epiglottis distance. During anesthesia laryngoscopy will be carried out by an experienced anesthesiologist and the view will be graded. Difficult laryngoscopy will be defined as poor laryngeal view.

The main outcome of the study is to compare the accuracy of ultrasound measured skin to epiglottis distance with the Mallampati score in predicting difficult laryngoscopy. Secondary outcomes include assessment of sensitivity specificity positive predictive value and negative predictive value of both methods.

The results of this study may help improve preoperative airway assessment and enhance patient safety by reducing unexpected difficult airway situations in anesthesia practice.