Bedside sonography by emergency physicians for the rapid identification of landmarks relevant to cricothyrotomy

Accuracy of identifying the cricothyroid membrane by anesthesia trainees and staff in a Canadian institution

“…In a study involving emergency physicians and 50 patients, localization of the cricothyroid membrane using ultrasonography took a mean of 24.32 sec (SD = 20.18 sec, 95% CI = 18.59 to 30.05 sec). 17 A recent small French study involving twelve residents found that identification of the cricothyroid membrane was easier to locate with ultrasonography than with direct palpation in a comparable amount of time. 18 The authors of both of these studies did not mention whether they took into account the time required for preparation of the ultrasonography device and other necessary equipment.…”

Airway management and oxygenation in obese patients

“…26 The emerging role of ultrasound in identifying airway anatomy presents the advantage of turning a blind technique into one that is guided 27 and offering the possibility to identify the cricothyroid membrane accurately in patients with large neck circumference and impalpable landmarks, irrespective of physician experience. 28 As challenges may be encountered in mask ventilation, supraglottic airway use, tracheal intubation, and cricothyroidotomy in the morbidly obese patient, a cautious approach is advised and awake tracheal intubation should be considered in patients with known or anticipated difficult airways. …”

“…34 Additional techniques for peri-induction oxygenation include supplemental nasopharyngeal oxygen insufflation, semi-recumbent position, continuous positive airway pressure (CPAP), positive end-expiratory pressure (PEEP), and pressure support ventilation applied before induction of general anesthesia in the spontaneous ventilating patient. [28][29][30][31] Baraka et al compared preoxygenation followed by nasopharyngeal oxygen insufflation (study group) with preoxygenation alone (control group) in morbidly obese patients placed in a 25°head-up position. 35 In the study group, 16 of 17 patients maintained oxygen saturation at 100% during four minutes of apnea.…”

“…27 En outre, l'échographie permet d'identifier précisément la membrane cricothyroïdienne chez les patients possédant une imposante circonférence du cou et des repères impalpables, indépendamment de l'expérience du médecin. 28 É tant donné les défis auxquels nous pourrions être confrontés lors de la ventilation au masque, de l'utilisation de dispositifs supraglottiques, de l'intubation trachéale et de la cricothyroïdotomie chez le patient obèse morbide, il est recommandé de faire preuve de prudence et d'envisager une intubation trachéale vigile pour les patients chez lesquels on anticipe des voies aériennes difficiles, ou dont les voies aériennes sont connues comme étant difficiles.…”

“…34 Parmi les autres techniques d'oxygénation péri-induction, citons l'insufflation nasopharyngée d'oxygène supplémentaire, la position semi-assise, la ventilation à pression positive continue (CPAP), la pression positive télé-expiratoire (PEEP) et l'aide inspiratoire -appliquées avant l'induction de l'anesthésie générale chez un patient respirant spontanément. [28][29][30][31] Baraka et coll. ont comparé une technique de préoxygénation suivie par l'insufflation nasopharyngée d'oxygène (groupe à l'étude) à une technique de préoxygénation seule (groupe témoin) chez des patients obèses morbides positionnés avec la tête élevée à un angle de 25°.…”