Efficacy of Surface Landmark Palpation for Identification of the Cricoid Cartilage in Obstetric Patients

Efficacy of Surface Landmark Palpation for Identification of the Cricoid Cartilage in Obstetric Patients

Rapid Sequence Induction (RSI), with cricoid pressure is advocated for all obstetric patients undergoing general anesthesia. Applying cricoid pressure correctly is crucial to prevent aspiration. Using Ultrasound guidance we will be assessing the ability of different disciplines of caregivers to correctly localize the cricoid cartilage in obstetric patients by anatomical landmark palpation.

Obstetric patients coming for elective cesarean delivery will be recruited for the study. Informed consent will be obtained from the patient. The participant (anesthesiologist, resident, nurse, or RT) will mark the center of the cricoid cartilage with the patient in the sniffing position, using fluorescent "invisible" ink. Another anesthesiologist who is expert in using ultrasound will find the proximal and distal margins of the cricoid cartilage an will draw a line at the middle of the 2 margins. Evaluation of the participant's assessment will be considered accurate if it falls within 5 mm from the ultrasound's measured line .The assessor will also be asked to score the ease of cricoid cartilage palpation between 1 to 10 using a visual analog scoring (VAS) scale. Total time taken for palpation will also be measured.

Inclusion Criteria:

• Patient 18 years and older
• ASA 1-2•Having singleton pregnancy.
• Gestational age >37.
• Elective cesarean section

Exclusion Criteria:

• Patient refusal.
• Renal failure.
• Severe preeclampsia.
• Non- scheduled caesarean delivery (urgent).
• Twin pregnancy.