Digital Palpation of the Cricothyroid Membrane Is Unreliable in Obese Laboring Patients

Obesity is a common marker of airway difficulty and may make a “can't intubate, can't oxygenate” scenario (and the need for surgical rescue) more likely. Obese obstetrical patients are particularly challenging to manage because of higher rates of oxygen consumption and airway edema. Identification of neck landmarks is critical in performing cricothyrotomy quickly, but obesity can obscure neck landmarks. Ultrasound may augment localization of the cricothyroid membrane, especially when landmarks are indistinct.

Researchers at a Canadian tertiary care academic center randomized 41 anesthesia providers to digitally palpate and mark the cricothyroid membrane in 28 obese or 28 nonobese term pregnant patients in uncomplicated labor. A single ultras…