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St Andrews Research Repository
Article . 2020 . Peer-reviewed
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Acta Anaesthesiologica Scandinavica
Article . 2020 . Peer-reviewed
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A marking of the cricothyroid membrane with extended neck returns to correct position after neck manipulation and repositioning

Authors: James Bowness; Wendy H. Teoh; Michael S. Kristensen; Andrew Dalton; Alexander L. Saint‐Grant; Alasdair Taylor; Simon Crawley; +3 Authors

A marking of the cricothyroid membrane with extended neck returns to correct position after neck manipulation and repositioning

Abstract

BackgroundEmergency front of neck airway access by anaesthetists carries a high failure rate and it is recommended to identify the cricothyroid membrane before induction of anaesthesia in patients with a predicted difficult airway. We have investigated whether a marking of the cricothyroid membrane done in the extended neck position remains correct after the patient's neck has been manipulated and subsequently repositioned.MethodsThe subject was first placed in the extended head and neck position and had the cricothyroid membrane identified and marked with 3 methods, palpation, ‘laryngeal handshake’ and ultrasonography and the distance from the suprasternal notch to the cricothyroid membrane was measured. The subject then moved off the table and sat on a chair and subsequently returned to the extended neck position and examinations were repeated.ResultsSkin markings of all 11 subjects lay within the boundaries of the cricothyroid membrane when the subject was repositioned back to the extended neck position and the median difference between the two measurements of the distance from the suprasternal notch was 0 mm (range 0‐2 mm).ConclusionThe cricothyroid membrane can be identified and marked with the subject in the extended neck position. Then the patient's position can be changed as needed, for example to the ‘sniffing’ neck position for conventional intubation. If a front of neck airway access is required during subsequent airway management, the patient can be returned expediently to the extended‐neck position, and the marking of the centre of the membrane will still be in the correct place.

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Keywords

RZ Other systems of medicine, Palpation, name=Anesthesiology and Pain Medicine, 610, DAS, Neck/diagnostic imaging, Thyroid Cartilage/diagnostic imaging, Cricoid Cartilage, Intratracheal, RZ, Thyroid Cartilage, /dk/atira/pure/subjectarea/asjc/2700/2703, Intubation, Intratracheal, Humans, Intubation, Neck, Ultrasonography

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    15
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Average
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
15
Top 10%
Average
Top 10%
Green
bronze