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

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 (P<0.001); mean difference 7.4 mm (4.9-9.9; P<0.001). CTM depths were increased in the severely obese group regardless of scanning plane, head and neck position, or transducer pressure (all P<0.001). There was excellent inter-observer reliability. CONCLUSIONS:Cricothyroid membrane depth is significantly increased in severely obese vs normal-weight parturients independently of scanning plane, head and neck position, or transducer pressure.

journal_name

Br J Anaesth

journal_title

British journal of anaesthesia

authors

Gadd K,Wills K,Harle R,Terblanche N

doi

10.1016/j.bja.2018.02.010

subject

Has Abstract

pub_date

2018-05-01 00:00:00

pages

1033-1039

issue

eissn

0007-0912

issn

1471-6771

pii

S0007-0912(18)30118-1

journal_volume

120

pub_type

杂志文章

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