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Relationship between severe obesity and depth to the cricothyroid membrane in third-trimester non-labouring parturients: a prospective observational study

Gadd, K, Wills, K ORCID: 0000-0003-3897-2908, Harle, R and Terblanche, N 2018 , 'Relationship between severe obesity and depth to the cricothyroid membrane in third-trimester non-labouring parturients: a prospective observational study' , British Journal of Anaesthesia, vol. 120, no. 5 , pp. 1033-1039 , doi: 10.1016/j.bja.2018.02.010.

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Abstract

Background: Severely obese parturients have increased 'cannot intubate, cannot oxygenate' risk during Caesarean section under general anaesthesia. Front-of-neck access (FONA) at the cricothyroid membrane (CTM) is definitive management; however, attempted FONA can fail. Point-of-care ultrasonography may provide useful information about CTM depth to aid FONA in obesity. This study determined the difference in CTM depth between severely obese and non-obese parturients, utilising ultrasonography.Methods: In this prospective observational study, two anaesthetists performed airway ultrasonography on 15 severely obese (BMI >45 kg m-2) and 15 normal-weight (BMI ≤25 kg m-2) parturients in the third trimester, using the transverse and longitudinal planes, sniffing and extended head positions, and nil and firm transducer pressures. The primary outcome was CTM depth (millimetres) measured in the transverse plane with the head extended and nil transducer pressure. Secondary outcomes included CTM depth measurements using other factor configurations. Intra-class correlation coefficients assessed the inter-observer reliability.Results: CTM depth measured in the transverse plane with head extended and nil transducer pressure was significantly greater in severely obese parturients, mean 18.0 mm (95% confidence interval 16.3-19.8), vs 10.6 mm (8.81-12.4) in non-obese (PConclusions: Cricothyroid membrane depth is significantly increased in severely obese vs normal-weight parturients independently of scanning plane, head and neck position, or transducer pressure.

Item Type: Article
Authors/Creators:Gadd, K and Wills, K and Harle, R and Terblanche, N
Keywords: airway management, intubation, oxygen inhalation therapy, pregnancy, ultrasonography
Journal or Publication Title: British Journal of Anaesthesia
Publisher: Oxford Univ Press
ISSN: 0007-0912
DOI / ID Number: 10.1016/j.bja.2018.02.010
Copyright Information:

© 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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