Trends in Anaesthesia and Critical Care最新文献

{"title":"The long-term influence of green nudges on the consumption of desflurane and on the carbon footprint of general anaesthesia: A retrospective study","authors":"Leonard Santen ,&nbsp;Florian Windler ,&nbsp;Mark Coburn ,&nbsp;Birgit Bette ,&nbsp;Se-Chan Kim ,&nbsp;Christian Bode ,&nbsp;Philippe Kruse","doi":"10.1016/j.tacc.2025.101592","DOIUrl":"10.1016/j.tacc.2025.101592","url":null,"abstract":"<div><h3>Introduction</h3><div>The medical sector is responsible for a significant share of greenhouse gas emissions. It is imperative that a transition towards ecological sustainability takes place. Nevertheless, initiatives for healthcare providers to reduce emissions remain limited in clinical practice, and climate-damaging behaviour persists. A salient example is the regular use of desflurane in anaesthesia. In order to promote sustainable clinical practice, the implementation of behavioural decision support mechanisms, so called nudges, could be a promising approach.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted to analyse the effectiveness of nudges to reduce the consumption of desflurane. The nudges comprised structural modifications to the workplace, with desflurane vaporisers being replaced with those for sevoflurane and isoflurane. The effectiveness of the nudges was evaluated by analysis of the desflurane's order volume. In addition, the emissions of greenhouse gases were normalised to the number of surgical procedures performed. Finally, the economic benefit of reduced desflurane consumption was investigated based on the purchase price.</div></div><div><h3>Results</h3><div>Following the implementation, desflurane was no longer utilised in the long term. Overall, these nudges resulted in a 91 % reduction in emissions of volatile anaesthetics per quarter, equivalent to 219 t CO₂e. Consequently, the average greenhouse gas emissions per surgical procedure were reduced by 42.2 kg CO₂e. Furthermore, the costs for volatile anaesthetics decreased by 63.9 %, amounting to a reduction of €18,237.28.</div></div><div><h3>Discussion</h3><div>The implementation of nudges has been demonstrated to lead to a cessation of desflurane consumption, thereby supporting the green transformation of the healthcare sector. In the future, green nudges favouring sustainable clinical practice are poised to assume greater significance as a cost-effective and readily implementable sustainability measure.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"64 ","pages":"Article 101592"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflection on “Recto-intercostal fascial plane block: A scoping review”","authors":"Tuhin Mistry ,&nbsp;Abhijit Sukumaran Nair","doi":"10.1016/j.tacc.2025.101593","DOIUrl":"10.1016/j.tacc.2025.101593","url":null,"abstract":"","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"65 ","pages":"Article 101593"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145223644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the efficiency of high flow nasal cannula oxygen and conventional nasal cannula oxygen in pediatric patients under sedation for gastrointestinal endoscopy: A prospective observational study","authors":"Sami Olcay Ozbay ,&nbsp;Mehmet Yilmaz ,&nbsp;Merve Yazici Kara ,&nbsp;Ayse Zeynep Turan Civraz ,&nbsp;Nurseda Dundar ,&nbsp;Ayten Saracoglu ,&nbsp;Kemal Tolga Saracoglu","doi":"10.1016/j.tacc.2025.101591","DOIUrl":"10.1016/j.tacc.2025.101591","url":null,"abstract":"<div><h3>Background</h3><div>Oxygenation during upper gastrointestinal (GI) endoscopy in pediatric patients is essential to prevent hypoxia and complications. High-flow nasal cannula oxygenation (HFNO) effectively improves oxygenation compared to conventional nasal cannula oxygenation (NCO). This study compares the efficacy of HFNO and NCO in minimizing hypoxia during sedation.</div></div><div><h3>Methods</h3><div>This prospective observational study included 82 pediatric patients aged 4–18 years with ASA scores I or II, all undergoing upper GI endoscopy under sedation. Patients received either HFNO or NCO, maintaining SpO2 above 93 %. The primary outcome was hypoxia incidence, while secondary outcomes included hypoxia duration, minimum SpO2 levels, and recovery measures. Statistical significance was set at p &lt; 0.05.</div></div><div><h3>Results</h3><div>Hypoxia occurred significantly less in the HFNO group (4.9 %) than in the NCO group (22.0 %, p = 0.023). HFNO also led to shorter hypoxia duration and higher minimum SpO2 values (88.5 % vs. 68.4 %, p = 0.034). There were no significant differences in procedure or recovery times, or vomiting rates. The HFNO group maintained better hemodynamic stability, including mean arterial pressure and respiratory rate.</div></div><div><h3>Conclusion</h3><div>HFNO proved more effective in reducing hypoxia incidence and duration compared to NCO in pediatric patients undergoing upper GI endoscopy. It also enhanced respiratory and hemodynamic stability, indicating its promise as a safer oxygenation method in practice.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"64 ","pages":"Article 101591"},"PeriodicalIF":0.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recto-intercostal fascial plane block: A scoping review","authors":"Prashant Sirohiya ,&nbsp;Ram Singh ,&nbsp;Brajesh Kumar Ratre ,&nbsp;Balbir Kumar","doi":"10.1016/j.tacc.2025.101590","DOIUrl":"10.1016/j.tacc.2025.101590","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The recto-intercostal fascial plane block (RIFPB) is a novel ultrasound-guided regional anesthesia technique intended to provide analgesia for the anterior thoracoabdominal wall, particularly the subxiphoid and epigastric regions. Unlike established modalities such as thoracic epidural, transversus abdominis plane (TAP) block, or parasternal intercostal plane block (PIPB)—which are limited by side-effect profiles or incomplete cranial/epigastric spread—RIFPB seeks to target intercostal nerves in a safe and relatively avascular plane. Early case reports suggest potential benefits in patients undergoing sternotomy or upper abdominal surgery, but the evidence base remains preliminary.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;This scoping review aimed to systematically map and synthesize the current evidence on RIFPB, focusing on its anatomical basis, technical feasibility, clinical applications, dermatomal coverage, and safety considerations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Eligibility criteria&lt;/h3&gt;&lt;div&gt;Eligible sources included cadaveric studies, letters, case reports, case series, abstracts, and conceptual reports describing the anatomical spread, technique, or clinical utility of RIFPB. Only studies published in English were considered. Randomized controlled trials were not identified.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Sources of evidence&lt;/h3&gt;&lt;div&gt;A comprehensive search was conducted across PubMed, Embase, Scopus, Cochrane Library, and Google Scholar from database inception to June 2025. Grey literature, including professional society proceedings (ASRA, ESRA) and preprint servers (medRxiv, Research Square), was also screened.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Charting methods&lt;/h3&gt;&lt;div&gt;Records were imported into EndNote, then transferred to Rayyan.ai for screening. Duplicates were removed manually. Title/abstract and full-text screening were independently performed by two reviewers, with discrepancies resolved by consensus or a third reviewer. A standardized data extraction form (Microsoft Excel) was used to capture study characteristics, technique details, dermatomal coverage, and outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Ten publications were included: six case reports/letters, one cadaveric study, one conceptual description, one case series, and one conference abstract. Most clinical reports described use in cardiac surgery, typically in combination with a PIPB for sternotomy analgesia. Two reports involved upper abdominal surgery. The cadaveric study demonstrated consistent dye spread between T6–T9, supporting the anatomical rationale for epigastric analgesia. Clinical studies variably reported sensory involvement from T5–T11, although testing methods were inconsistent. No randomized controlled trials were identified. Across available evidence, RIFPB was consistently described as technically feasible, safe, and free from major complications, including in pediatric patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;RIFPB appears to be a feasible, anat","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"64 ","pages":"Article 101590"},"PeriodicalIF":0.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological considerations regarding “A novel negative pressure isolation device reduces aerosol exposure: A randomized controlled trial”","authors":"Musawer Khan,&nbsp;Nauman Khan,&nbsp;Asif Ullah Khan,&nbsp;Javed Iqbal,&nbsp;Brijesh Sathian","doi":"10.1016/j.tacc.2025.101589","DOIUrl":"10.1016/j.tacc.2025.101589","url":null,"abstract":"","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"64 ","pages":"Article 101589"},"PeriodicalIF":0.7,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effects of dexmedetomidine versus labetalol on hemodynamic stress response to laryngoscopy and tracheal intubation: A systematic review and meta-analysis of randomized controlled trials","authors":"Milton Morais Correia Neto ,&nbsp;Mauricio Cardoso Paz ,&nbsp;Ana Carolina Oliveira Crisóstomo ,&nbsp;Isabella Soares Marques Rabelo ,&nbsp;Beatriz Guimarães Amorim Luna ,&nbsp;Priscila Ferreira de Lima e Souza","doi":"10.1016/j.tacc.2025.101588","DOIUrl":"10.1016/j.tacc.2025.101588","url":null,"abstract":"<div><h3>Background</h3><div>Laryngoscopy and tracheal intubation provoke a sympathetic surge, leading to transient elevations in heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure, potentially increasing perioperative cardiovascular risk. Dexmedetomidine and labetalol are both used to attenuate this response, but their comparative efficacy remains unclear. This study aimed to synthesize current evidence comparing their effects on peri-intubation hemodynamic responses.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Embase, Scopus, Web of Science, Cochrane, and Google Scholar were searched for randomized controlled trials comparing dexmedetomidine with labetalol. Primary outcomes were heart rate and systolic blood pressure; secondary outcomes included diastolic blood pressure and mean arterial pressure. Data were analyzed using random-effects models. Risk of bias was assessed using the RoB 2 tool, and certainty of evidence was evaluated with the GRADE framework.</div></div><div><h3>Results</h3><div>Eight randomized trials involving 514 patients were included. Dexmedetomidine significantly reduced systolic blood pressure at 3, 5, and 10 min post-intubation (mean difference −7.46 to −8.62 mmHg) compared to labetalol; the difference at 1 min (−3.96 mmHg) was not statistically significant. Heart rate was significantly reduced at all timepoints (mean difference −10.59 to −14.05 bpm). Reductions in diastolic blood pressure and mean arterial pressure were also consistent and statistically significant. Adverse events were infrequently reported. Two studies documented bradycardia and hypotension, with slightly higher rates in the dexmedetomidine group in one study and in the labetalol group in another. The remaining studies reported no adverse events, though definitions varied substantially.</div></div><div><h3>Conclusions</h3><div>Dexmedetomidine was associated with greater attenuation of the hemodynamic response to intubation compared to labetalol. However, the certainty of evidence ranged from low to moderate and safety data were limited. Further high-quality trials are warranted to refine dosing strategies and assess applicability in broader patient populations.</div></div><div><h3>Trial registration</h3><div>The protocol for this meta-analysis has been registered in PROSPERO (CRD420251007007).</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"64 ","pages":"Article 101588"},"PeriodicalIF":0.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The modified renal angina index and renal outcomes in critically ill patients: a prospective cohort study","authors":"Mohamed Anas P. ,&nbsp;Vishal Shanbhag ,&nbsp;Attur Ravindra Prabhu ,&nbsp;Shankar Prasad Nagaraju ,&nbsp;Dharshan Rangaswamy ,&nbsp;Srinivas Vinayak Shenoy ,&nbsp;Mohan Varadarayanahalli Bhojaraja ,&nbsp;Indu Ramachandra Rao","doi":"10.1016/j.tacc.2025.101587","DOIUrl":"10.1016/j.tacc.2025.101587","url":null,"abstract":"<div><h3>Introduction</h3><div>Existing risk prediction tools for acute kidney injury (AKI) have focused on the prediction of AKI occurrence, but few have addressed clinically meaningful outcomes such as the need for dialysis, mortality and kidney recovery. We sought to study the performance of the modified renal angina index (mRAI) for prediction of major adverse kidney events 30 (MAKE30).</div></div><div><h3>Methodology</h3><div>This prospective single-centre observational study was conducted in the medical ICUs of a tertiary care hospital in India from March 2023 to July 2024. We included consecutive adult ICU patients with hospital stays ≥48 h, excluding those with end-stage kidney disease, prior kidney transplantation, or needing dialysis at admission. The mRAI was calculated 24 h after ICU admission based on condition scores and changes in serum creatinine, as described by Matsuura et al. The primary outcome was MAKE30, a composite of in-hospital mortality, new renal replacement therapy (RRT) initiation, or persistent renal dysfunction by discharge or day 30. The area under the receiver operating curve (AUROC) was used to assess the performance of the mRAI for MAKE30 prediction and compared with other scores.</div></div><div><h3>Results</h3><div>Among 750 eligible patients, 326 (43.4 %) experienced MAKE30. The mRAI had an AUROC of 0.75 (95 % CI: 0.70–0.78) for MAKE30 prediction, which was numerically higher than that of the SEA-MAKE score (AUROC 0.70), SOFA score (AUROC 0.70) and APACHE II score (AUROC 0.68).</div></div><div><h3>Conclusion</h3><div>The mRAI demonstrated good discriminative ability for MAKE30 prediction in critically ill patients. While this may be a promising tool to guide clinical decision-making, further research is warranted.</div></div><div><h3>Trial registration</h3><div>Clinical Trial Registry Identifier: CTRI/2023/04/051884.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"64 ","pages":"Article 101587"},"PeriodicalIF":0.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the conventional: Adapting the EZ-blocker® for one-lung ventilation in a tracheostomized patient","authors":"Sara Neves ,&nbsp;Inês Correia ,&nbsp;António Carlos Fiuza","doi":"10.1016/j.tacc.2025.101585","DOIUrl":"10.1016/j.tacc.2025.101585","url":null,"abstract":"<div><div>Managing one-lung ventilation (OLV) in tracheostomized patients presents distinct challenges due to altered airway anatomy and limited device compatibility, particularly when complete pulmonary exclusion is required. Standard techniques may be inadequate or impractical in such complex cases. This case report describes an adaptation of the EZ-Blocker® in a tracheostomized patient undergoing right lower lobectomy. By strategically adjusting the positioning of the endobronchial cuffs and integrating a continuous aspiration system, successful and complete right lung exclusion was achieved, facilitating ideal surgical exposure. This tailored approach not only preserved airway stability but also minimized the risk of complications associated with alternative methods. Our experience highlights the versatility of the EZ-Blocker® and expands its potential application in nontraditional airway management scenarios, offering a valuable option for anesthesiologists facing similar challenges in thoracic surgery.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"64 ","pages":"Article 101585"},"PeriodicalIF":0.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study on prediction of paediatric endotracheal tube size by ultrasonography little finger breadth and age based formula: A prospective observational study","authors":"Mathew Antony ,&nbsp;V. Arun ,&nbsp;Gaurang J. Kothari","doi":"10.1016/j.tacc.2025.101586","DOIUrl":"10.1016/j.tacc.2025.101586","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound is said to be a reliable, safe and non-invasive modality for evaluation of upper airways and a useful tool for estimating the proper size of the ET tube. Transverse subglottic diameter measured by ultrasound may be used to choose the correct size of tracheal tube by predicting the outer diameter of ET tube. There are studies comparing ultrasonography with age-based formulas and ultrasonography with little finger breadth for ET tube estimation. But there are no studies comparing all three techniques. In this study we wanted to find the utility of ultrasound to predict ET tube size in paediatric population.</div></div><div><h3>Methods</h3><div>This was a prospective observational study involving 30 paediatric patients aged 6 months to 6 years undergoing elective surgery. Preoperatively, the breadth of the distal phalanx of little finger at level of distal inter-phalangeal groove of all patients was measured with the help of a calliper. Measurement of transverse subglottic diameter at cricoid level was performed using a portable ultrasound machine. An uncuffed ET tube with the OD close to the subglottic diameter measured by ultrasound was used to intubate the patient.</div></div><div><h3>Results</h3><div>Mean values for age and weight were 2.25 ± 1.87 and 11.10 ± 3.65, respectively. Mean values for USG guided MTDSA (Minimal Transverse Diameter of Subglottic Airway) diameter vs. O.D (Outer diameter) of ET tube were 6.51 ± 0.91 vs. 6.33 ± 0.88, respectively. Mean values for age-based formula size vs. I.D (Inner diameter) of ET tube were 4.35 ± 0.56 vs. 4.62 ± 0.64, respectively. Mean values for little finger breadth vs. O.D. of ET tube were 6.52 ± 1.04 vs. 6.33 ± 0.88, respectively. The scatter plot showed a correlation (r) between USG-guided MTDSA measurement and the OD of the ET tube used (r value = 0.95) and Bland-Altman analysis (mean bias of 0.16). The correlation between little finger breadth and OD of the ET tube showed a correlation (r) of 0.83 in the scatter plot. The mean bias shown by Bland-Altman analysis using the little finger breadth method was 0.17. The scatter plot between age-based formula and ID of ET tube showed a correlation (r) of 0.92, and Bland-Altman analysis showed a mean bias of 0.27. The highest level of correlation was observed between ultrasound measurement and OD of the ET tube used (r = 0.95). Least bias was found between ultrasound measurement and OD of ET tube used (−0.16).</div></div><div><h3>Conclusions</h3><div>Ultrasound predicted the correct tube size in 80 % of the population. Ultrasound is a better tool compared to conventional age-based formulas and the little finger breadth method in predicting the appropriate size of the ET tube in paediatric population.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"64 ","pages":"Article 101586"},"PeriodicalIF":0.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a multiple logistic regression model to predict depth of the cricothyroid membrane in the adult surgical population","authors":"Umair Ansari ,&nbsp;Clementine Stubbs ,&nbsp;Siew Wan Hee ,&nbsp;Shubha Srinivasa Reddy ,&nbsp;Cyprian Mendonca","doi":"10.1016/j.tacc.2025.101584","DOIUrl":"10.1016/j.tacc.2025.101584","url":null,"abstract":"<div><h3>Background</h3><div>To adequately prepare for a difficult airway requiring emergency front of neck access, it is recommended that anaesthetists identify the cricothyroid membrane (CTM) before the induction of anaesthesia. In addition, the technique and success of eFONA depends on the depth of CTM. This study aims to develop a multiple logistic regression model using patient characteristics and airway assessment parameters to predict depth of the CTM.</div></div><div><h3>Methods</h3><div>The study was performed at University Hospitals Coventry and Warwickshire NHS Trust from October 2018 to February 2022. Following written informed consent and detailed airway assessment, ultrasonography of the neck was performed and depth of CTM was measured in supine neck extended position. We inspected the relationship of age, sex, weight, BMI, Mallampati score, thyromental distance, sternomental distance, inter-incisor distance, jaw protrusion, CTM palpability, neck extension and neck circumference with CTM depth. Each of these covariates were included in simple univariate logistic regression model as predictor with binary CTM as the response. Covariates that showed significance at p-value of 0.10 were included in a multiple logistic regression model.</div></div><div><h3>Results</h3><div>We analysed the data from 2578 patients. The mean (SD) depth of the CTM in male patients was 9.4 (2.7) mm and in female patients was 9.7 (3.1) mm. In simple univariate logistic regression, we found sex, weight, BMI, Mallampati score, sternomental distance, CTM palpability and neck circumference all to have a statistically significant relationship with CTM depth. There was a strong positive correlation between neck circumference and CTM depth.</div></div><div><h3>Conclusion</h3><div>We have developed a multiple logistic regression model for predicting CTM depth ≤13 mm based on sex, BMI, CTM palpability, sternomental distance and neck circumference with good sensitivity (0.80) and specificity (0.85).</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"64 ","pages":"Article 101584"},"PeriodicalIF":0.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}