Journal of Anesthesia

, Volume 32, Issue 5, pp 768–773 | Cite as

Accuracy of identifying the cricothyroid membrane in children using palpation

  • Betul BasaranEmail author
  • Ayse Ilksen Egilmez
  • Necat Alatas
  • Aysun Ankay Yilbas
  • Mehmet Sargin
Clinical Report


Accurate identification of the cricothyroid membrane (CTM) has paramount importance in the event of a ‘cannot intubate, cannot oxygenate’ scenario. We sought to determine the ability of anesthesiologists to correctly identify the CTM in obese and non-obese children. Anesthesiologists were asked to mark the entry point of the cricothyroidotomy device with an ultraviolet invisible pen on obese and non-obese (BMI < 95th percentile for age and sex) children aged 7–12 years. A correct estimation was defined as a mark made between the upper and lower borders of the CTM and within the 3-mm midline. Twenty anesthesiologists palpated 30 obese and 50 non-obese children. The CTM was accurately identified with digital palpation in a total 55% of children, and there were no differences inaccurate identification rates of the CTM between obese and non-obese children [57 vs. 54%, respectively; median difference 3%; 95% confidence interval (− 20 to 25%); p = 0.82]. Accuracy was not correlated with any demographic or morphometric features of the children. Percutaneous identification of the CTM in children aged 7–12 years was poor and not significantly different for obese and non-obese children. Pre-procedural ultrasonography may help to identify the landmarks for cricothyroidotomy.


Child Difficult airway Ultrasound 


Compliance with ethical standards

Ethics approval

All study documents and procedures were approved by the review board at Necmettin Erbakan University, Konya, Turkey (protocol no: 2017/937; chairperson Dr. Acıkgozoglu) on May 26 2017, and conducted in accordance with the Declaration of Helsinki.

Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyKonya Training and Research HospitalKonyaTurkey
  2. 2.Department of OtorhinolaryngologyKonya Training and Research HospitalKonyaTurkey
  3. 3.Department of Anesthesiology and Reanimation, Faculty of MedicineHacettepe UniversityAnkaraTurkey

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