title: A randomised cross-over comparison of the transverse and longitudinal techniques for ultrasound-guided identification of the cricothyroid membrane in morbidly obese subjects.
abstract: We compared the transverse and longitudinal approaches to ultrasound-guided identification of the cricothyroid membrane, to determine which was faster and more successful. Forty-two anaesthetists received a one-hour structured training programme consisting of e-learning, a lecture and hands-on training, and then applied both techniques in a randomised, cross-over sequence to obese females with body mass index 39.0 - 43.9 kg.m(-2) . The mean (SD) time to identify the cricothyroid membrane was 24.0 (12.4) s using the transverse technique compared with 37.6 (17.9) s for the longitudinal technique (p = 0.0003). Successful identification of the cricothyroid membrane was achieved by 38 (90%) anaesthetists using either technique. All anaesthetists were successful in identifying the cricothyroid membrane with at least one of the techniques. We advocate the learning and application of these two techniques for identification of the cricothyroid membrane before starting anaesthesia in difficult patients, especially when anatomical landmarks are impalpable. Further use in emergency situations is feasible, if clinicians have experience and the ultrasound machine is readily available.
authors.affiliation: Department of Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: M S
authors.initials: MS
authors.lastname: Kristensen
authors.affiliation: Wendy Teoh Pte. Ltd, Private Anaesthesia Practice, Singapore.
authors.forename: W H
authors.initials: WH
authors.lastname: Teoh
authors.affiliation: Department of Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: S S
authors.initials: SS
authors.lastname: Rudolph
authors.affiliation: Department of Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Hesselfeldt
authors.affiliation: Department of Anaesthesia, Sjaellands University Hospital, University of Copenhagen, Roskilde, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Børglum
authors.affiliation: Department of Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: M F
authors.initials: MF
authors.lastname: Tvede
mesh_terms: D000328:Adult; D058109:Airway Management / Q000379:methods*; D000072077:Anesthetists / Q000193:education*; D003413:Cricoid Cartilage / Q000000981:diagnostic imaging*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000000981:diagnostic imaging*; D013957:Thyroid Cartilage / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional
keywords: airway assessment: co-existing disease; cricothyroid membrane; cricothyroidotomy; management of difficult airway: obese patient; obesity: airway evaluation; upper airway anatomy