Skip to main content
SpringerLink
Log in

Accuracy of identifying the cricothyroid membrane in children using palpation

  • Clinical Report
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, O’Sullivan EP, Woodall NM, Ahmad I, Difficult Airway Society intubation guidelines working g. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827–48.

    Article  CAS  Google Scholar 

  2. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A, American Society of Anesthesiologists Task Force on Management of the Difficult A. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251–70.

    Article  Google Scholar 

  3. Law JA. Deficiencies in locating the cricothyroid membrane by palpation: we can’t and the surgeons can’t, so what now for the emergency surgical airway? Can J Anaesth. 2016;63(7):791–6.

    Article  Google Scholar 

  4. Defining Childhood Obesity. October 20, 2016. https://www.cdc.gov/obesity/childhood/defining.html. Accessed 10 Aug 2017

  5. Kristensen MS. Ultrasonography in the management of the airway. Acta Anaesthesiol Scand. 2011;55(10):1155–73.

    Article  CAS  Google Scholar 

  6. Nicholls SE, Sweeney TW, Ferre RM, Strout TD. Bedside sonography by emergency physicians for the rapid identification of landmarks relevant to cricothyrotomy. Am J Emerg Med. 2008;26(8):852–6.

    Article  Google Scholar 

  7. You-Ten KE, Desai D, Postonogova T, Siddiqui N. Accuracy of conventional digital palpation and ultrasound of the cricothyroid membrane in obese women in labour. Anaesthesia. 2015;70(11):1230–4.

    CAS  PubMed  Google Scholar 

  8. Klucka J, Stourac P, Stoudek R, Toukalkova M, Harazim H, Kosinova M. Controversies in pediatric perioperative airways. Biomed Res Int. 2015;2015:368761.

    Article  Google Scholar 

  9. Prunty SL, Aranda-Palacios A, Heard AM, Chapman G, Ramgolam A, Hegarty M, Vijayasekaran S, von Ungern-Sternberg BS. The ‘Can’t intubate can’t oxygenate’ scenario in pediatric anesthesia: a comparison of the Melker cricothyroidotomy kit with a scalpel bougie technique. Paediatr Anaesth. 2015;25(4):400–4.

    Article  Google Scholar 

  10. Elliott DS, Baker PA, Scott MR, Birch CW, Thompson JM. Accuracy of surface landmark identification for cannula cricothyroidotomy. Anaesthesia. 2010;65(9):889–94.

    Article  CAS  Google Scholar 

  11. Aslani A, Ng SC, Hurley M, McCarthy KF, McNicholas M, McCaul CL. Accuracy of identification of the cricothyroid membrane in female subjects using palpation: an observational study. Anesth Analg. 2012;114(5):987–92.

    Article  Google Scholar 

  12. Lamb A, Zhang J, Hung O, Flemming B, Mullen T, Bissell MB, Arseneau I. Accuracy of identifying the cricothyroid membrane by anesthesia trainees and staff in a Canadian institution. Can J Anaesth. 2015;62(5):495–503.

    Article  Google Scholar 

  13. Campbell M, Shanahan H, Ash S, Royds J, Husarova V, McCaul C. The accuracy of locating the cricothyroid membrane by palpation—an intergender study. BMC Anesthesiol. 2014;14:108.

    Article  Google Scholar 

  14. Ajmani ML. A metrical study of the laryngeal skeleton in adult Nigerians. J Anat. 1990;171:187–91.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Randestad A, Lindholm CE, Fabian P. Dimensions of the cricoid cartilage and the trachea. Laryngoscope. 2000;110(11):1957–61.

    Article  CAS  Google Scholar 

  16. Ezri T, Gewurtz G, Sessler DI, Medalion B, Szmuk P, Hagberg C, Susmallian S. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia. 2003;58(11):1111–4.

    Article  CAS  Google Scholar 

  17. Nafiu OO, Reynolds PI, Bamgbade OA, Tremper KK, Welch K, Kasa-Vubu JZ. Childhood body mass index and perioperative complications. Paediatr Anaesth. 2007;17(5):426–30.

    Article  Google Scholar 

  18. Fox S. Can’t intubate can’t ventilate. July 25, 2017; http://pedemmorsels.com/cant-intubate-cant-ventilate/. Accessed 16 Dec 2017

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Konya Training and Research Hospital, Meram Yeni Yol Street, 42090, Konya, Turkey

    Betul Basaran, Ayse Ilksen Egilmez & Mehmet Sargin

  2. Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey

    Necat Alatas

  3. Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Aysun Ankay Yilbas

Authors
  1. Betul Basaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayse Ilksen Egilmez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Necat Alatas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aysun Ankay Yilbas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehmet Sargin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Betul Basaran.

Ethics declarations

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.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Basaran, B., Egilmez, A.I., Alatas, N. et al. Accuracy of identifying the cricothyroid membrane in children using palpation. J Anesth 32, 768–773 (2018). https://doi.org/10.1007/s00540-018-2538-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-018-2538-0

Keywords

Search

Navigation