Ultrasound, particularly in the longitudinal median view, provides accurate information on the distance of skin-to-ligament flavum in infants and children. With reference to the measured distance, epidural puncture can be performed with minimal risk of dural puncture (upper limit of 95% CI = 1.67%).

BACKGROUND Tracheal intubation using a double-lumen endobronchial tube (DLT) causes postoperative sore throat. OBJECTIVE To determine the effect of two-handed jaw thrust on postoperative sore throat in patients requiring insertion of a DLT. DESIGN A randomised study. SETTING A tertiary teaching hospital from December 2017 to May 2018. PATIENTS One-hundred and six patients undergoing one-lung anaesthesia. INTERVENTIONS Patients were allocated to one of two groups (n=53 each). In the jaw thrust group, the two-handed jaw thrust manoeuvre was applied at intubation and advancement of the DLT. In the control group, conventional intubation with a sham jaw thrust was performed. MAIN OUTCOME MEASURES Incidence of sore throat at 1, 6 and 24 h postoperatively. RESULTS The incidence of sore throat at 6 h postoperatively was higher in the control group than in the jaw thrust group [31 (59%) vs. 14 (26%), risk ratio (95% confidence interval) 0.45 (0.27 to 0.75), P < 0.01]. The overall incidence of sore throat was higher in the control group than in the jaw thrust group [35 (66%) vs. 18 (34%), risk ratio (95% confidence interval) 0.51 (0.34 to 0.78), P < 0.01]. CONCLUSION The jaw thrust manoeuvre can reduce the incidence of sore throat in patients undergoing DLT insertion for one-lung ventilation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03331809.