Accuracy of identification of the cricothyroid membrane in female subjects using palpation: an observational study

The cricothyroid membrane (CTM) is the recommended site of access to the airway during cricothyroidotomy to provide emergency oxygenation. Despite the apparent simplicity of the technique, this rescue maneuver frequently fails to achieve its goals and complications are numerous. The reasons for this...

Ausführliche Beschreibung

Gespeichert in:

Bibliographische Detailangaben
Veröffentlicht in:	Anesthesia and analgesia Jg. 114; H. 5; S. 987
Hauptverfasser:	Aslani, Anastasia, Ng, Su-Cheen, Hurley, Michael, McCarthy, Kevin F, McNicholas, Michelle, McCaul, Conan Liam
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 01.05.2012
Schlagworte:	Adult Body Mass Index Body Weight - physiology Clinical Competence Female Humans Laryngeal Muscles - anatomy & histology Laryngeal Muscles - diagnostic imaging Manikins Membranes - anatomy & histology Mouth - anatomy & histology Neck - anatomy & histology Obesity - pathology Palpation - methods Point-of-Care Systems Reproducibility of Results Snoring - physiopathology Supine Position - physiology Ultrasonography
ISSN:	1526-7598, 1526-7598
Online-Zugang:	Weitere Angaben
Tags:	Tag hinzufügen Keine Tags, Fügen Sie den ersten Tag hinzu!

Abstract	The cricothyroid membrane (CTM) is the recommended site of access to the airway during cricothyroidotomy to provide emergency oxygenation. Despite the apparent simplicity of the technique, this rescue maneuver frequently fails to achieve its goals and complications are numerous. The reasons for this failure are unclear. We sought to determine the ability of physicians to correctly identify the CTM in female patients. Using fluorescent "invisible" ink, the physician was asked to mark the CTM with the patient in the supine neutral position and then with the head extended. The actual level was identified using ultrasound and the distance between the actual and estimated margin of the CTM was measured. A correct estimation was defined as a mark made between the upper and lower limits of the membrane and within 5 mm of midline. Participants were also asked to assess the ease of CTM palpation using a 10-cm visual analog scoring (VAS) scale. Fifty-six patients participated of whom 15 were obese. In the supine neutral neck position, the CTM was identified in 10/41 vs 0/15 (P = 0.048) in nonobese versus obese, respectively. Of the 46 incorrectly identified CTMs in this position, 24 were above (maximum 3 cm) and 22 below (maximum 3 cm) the actual level. Similar results were observed when the patients were placed with the neck in the extended position; the CTM was identified correctly in 12/41 vs 1/15 nonobese and obese patients, respectively. The range of values was also extensive; the estimation of the position of the membrane was as high as 2.5 cm above and 4 cm below the actual level, and up to 1.6 cm laterally. Participating doctors found palpation of the CTM subjectively more difficult in the obese than nonobese groups; VAS score for palpation difficulty was 5.25 ± 2.5 vs 3.3 ± 2.5, respectively, P = 0.005. Using multiple linear regression, VAS scores for palpation correlated negatively with increased patient height (P < 0.001) and greater thyromental distance (P = 0.006), and correlated positively with increased sternomental distance (P = 0.011) and neck circumference (P = 0.001). Misidentification of the CTM in female patients is common and its localization is less precise in those who are obese. This has implications for the likely success of invasive airway access via the CTM.
AbstractList	The cricothyroid membrane (CTM) is the recommended site of access to the airway during cricothyroidotomy to provide emergency oxygenation. Despite the apparent simplicity of the technique, this rescue maneuver frequently fails to achieve its goals and complications are numerous. The reasons for this failure are unclear. We sought to determine the ability of physicians to correctly identify the CTM in female patients.BACKGROUNDThe cricothyroid membrane (CTM) is the recommended site of access to the airway during cricothyroidotomy to provide emergency oxygenation. Despite the apparent simplicity of the technique, this rescue maneuver frequently fails to achieve its goals and complications are numerous. The reasons for this failure are unclear. We sought to determine the ability of physicians to correctly identify the CTM in female patients.Using fluorescent "invisible" ink, the physician was asked to mark the CTM with the patient in the supine neutral position and then with the head extended. The actual level was identified using ultrasound and the distance between the actual and estimated margin of the CTM was measured. A correct estimation was defined as a mark made between the upper and lower limits of the membrane and within 5 mm of midline. Participants were also asked to assess the ease of CTM palpation using a 10-cm visual analog scoring (VAS) scale.METHODSUsing fluorescent "invisible" ink, the physician was asked to mark the CTM with the patient in the supine neutral position and then with the head extended. The actual level was identified using ultrasound and the distance between the actual and estimated margin of the CTM was measured. A correct estimation was defined as a mark made between the upper and lower limits of the membrane and within 5 mm of midline. Participants were also asked to assess the ease of CTM palpation using a 10-cm visual analog scoring (VAS) scale.Fifty-six patients participated of whom 15 were obese. In the supine neutral neck position, the CTM was identified in 10/41 vs 0/15 (P = 0.048) in nonobese versus obese, respectively. Of the 46 incorrectly identified CTMs in this position, 24 were above (maximum 3 cm) and 22 below (maximum 3 cm) the actual level. Similar results were observed when the patients were placed with the neck in the extended position; the CTM was identified correctly in 12/41 vs 1/15 nonobese and obese patients, respectively. The range of values was also extensive; the estimation of the position of the membrane was as high as 2.5 cm above and 4 cm below the actual level, and up to 1.6 cm laterally. Participating doctors found palpation of the CTM subjectively more difficult in the obese than nonobese groups; VAS score for palpation difficulty was 5.25 ± 2.5 vs 3.3 ± 2.5, respectively, P = 0.005. Using multiple linear regression, VAS scores for palpation correlated negatively with increased patient height (P < 0.001) and greater thyromental distance (P = 0.006), and correlated positively with increased sternomental distance (P = 0.011) and neck circumference (P = 0.001).RESULTSFifty-six patients participated of whom 15 were obese. In the supine neutral neck position, the CTM was identified in 10/41 vs 0/15 (P = 0.048) in nonobese versus obese, respectively. Of the 46 incorrectly identified CTMs in this position, 24 were above (maximum 3 cm) and 22 below (maximum 3 cm) the actual level. Similar results were observed when the patients were placed with the neck in the extended position; the CTM was identified correctly in 12/41 vs 1/15 nonobese and obese patients, respectively. The range of values was also extensive; the estimation of the position of the membrane was as high as 2.5 cm above and 4 cm below the actual level, and up to 1.6 cm laterally. Participating doctors found palpation of the CTM subjectively more difficult in the obese than nonobese groups; VAS score for palpation difficulty was 5.25 ± 2.5 vs 3.3 ± 2.5, respectively, P = 0.005. Using multiple linear regression, VAS scores for palpation correlated negatively with increased patient height (P < 0.001) and greater thyromental distance (P = 0.006), and correlated positively with increased sternomental distance (P = 0.011) and neck circumference (P = 0.001).Misidentification of the CTM in female patients is common and its localization is less precise in those who are obese. This has implications for the likely success of invasive airway access via the CTM.CONCLUSIONSMisidentification of the CTM in female patients is common and its localization is less precise in those who are obese. This has implications for the likely success of invasive airway access via the CTM. The cricothyroid membrane (CTM) is the recommended site of access to the airway during cricothyroidotomy to provide emergency oxygenation. Despite the apparent simplicity of the technique, this rescue maneuver frequently fails to achieve its goals and complications are numerous. The reasons for this failure are unclear. We sought to determine the ability of physicians to correctly identify the CTM in female patients. Using fluorescent "invisible" ink, the physician was asked to mark the CTM with the patient in the supine neutral position and then with the head extended. The actual level was identified using ultrasound and the distance between the actual and estimated margin of the CTM was measured. A correct estimation was defined as a mark made between the upper and lower limits of the membrane and within 5 mm of midline. Participants were also asked to assess the ease of CTM palpation using a 10-cm visual analog scoring (VAS) scale. Fifty-six patients participated of whom 15 were obese. In the supine neutral neck position, the CTM was identified in 10/41 vs 0/15 (P = 0.048) in nonobese versus obese, respectively. Of the 46 incorrectly identified CTMs in this position, 24 were above (maximum 3 cm) and 22 below (maximum 3 cm) the actual level. Similar results were observed when the patients were placed with the neck in the extended position; the CTM was identified correctly in 12/41 vs 1/15 nonobese and obese patients, respectively. The range of values was also extensive; the estimation of the position of the membrane was as high as 2.5 cm above and 4 cm below the actual level, and up to 1.6 cm laterally. Participating doctors found palpation of the CTM subjectively more difficult in the obese than nonobese groups; VAS score for palpation difficulty was 5.25 ± 2.5 vs 3.3 ± 2.5, respectively, P = 0.005. Using multiple linear regression, VAS scores for palpation correlated negatively with increased patient height (P < 0.001) and greater thyromental distance (P = 0.006), and correlated positively with increased sternomental distance (P = 0.011) and neck circumference (P = 0.001). Misidentification of the CTM in female patients is common and its localization is less precise in those who are obese. This has implications for the likely success of invasive airway access via the CTM.
Author	McNicholas, Michelle McCaul, Conan Liam Ng, Su-Cheen Aslani, Anastasia Hurley, Michael McCarthy, Kevin F
Author_xml	– sequence: 1 givenname: Anastasia surname: Aslani fullname: Aslani, Anastasia organization: Department of Anaesthesia, The Rotunda Hospital, Dublin 1, Ireland – sequence: 2 givenname: Su-Cheen surname: Ng fullname: Ng, Su-Cheen – sequence: 3 givenname: Michael surname: Hurley fullname: Hurley, Michael – sequence: 4 givenname: Kevin F surname: McCarthy fullname: McCarthy, Kevin F – sequence: 5 givenname: Michelle surname: McNicholas fullname: McNicholas, Michelle – sequence: 6 givenname: Conan Liam surname: McCaul fullname: McCaul, Conan Liam
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/22366848$$D View this record in MEDLINE/PubMed
BookMark	eNpNkElPwzAQhS1URBf4Bwj5yCXFS-LY3KqqLFIFFzhHXibUVTbsBCn_nlKKxOnNPH3zNHpzNGnaBhC6pmRJGeV3q5fNkhhCOXAqWapyYvQZmtGMiSTPlJz8m6doHuOeEEKJFBdoyhgXQqZyhsLK2iFoO-K2xN5B0_vSW937tvlx-h1gG7xt-90YWu9wDbUJugHsG1xCrSvAcTB7sH3EQ_TNB-501R3v77E-ZJgI4eu46wrHfnDjJTovdRXh6qQL9P6weVs_JdvXx-f1aptYLhlPcuM401lJbUozMEJpawgXGXCXZ5DmSuWpM1RzwqxMTSqVIrq0LhXEcE4pW6Db39wutJ8DxL6ofbRQVYf32yEWlBBFmRSCHNCbEzqYGlzRBV_rMBZ_PbFv9JlvEA
CitedBy_id	crossref_primary_10_1016_j_ccc_2025_02_009 crossref_primary_10_1016_j_tacc_2018_06_001 crossref_primary_10_1213_XAA_0000000000000091 crossref_primary_10_1097_ACO_0000000000000529 crossref_primary_10_1007_s00101_023_01280_6 crossref_primary_10_1177_0194599817697047 crossref_primary_10_1007_s12630_015_0326_y crossref_primary_10_1002_cre2_167 crossref_primary_10_1016_j_ajem_2018_07_027 crossref_primary_10_1097_EJA_0000000000001230 crossref_primary_10_1177_0003134821995075 crossref_primary_10_1111_anae_14399 crossref_primary_10_1186_s12871_017_0366_7 crossref_primary_10_1111_anae_13465 crossref_primary_10_1111_anae_13466 crossref_primary_10_1111_aas_13232 crossref_primary_10_1080_00016489_2021_1982147 crossref_primary_10_1007_s12630_013_0020_x crossref_primary_10_1177_0310057X211066927 crossref_primary_10_1016_j_bja_2018_10_003 crossref_primary_10_1016_j_chest_2020_09_083 crossref_primary_10_1016_j_ajem_2017_02_032 crossref_primary_10_1186_s12873_018_0156_7 crossref_primary_10_1111_anae_14706 crossref_primary_10_1213_ANE_0b013e31823a84ef crossref_primary_10_1007_s40136_022_00419_0 crossref_primary_10_1016_j_anclin_2015_02_001 crossref_primary_10_1007_s10877_017_0090_3 crossref_primary_10_1097_AIA_0000000000000277 crossref_primary_10_1007_s00540_014_1844_4 crossref_primary_10_1016_j_tacc_2025_101584 crossref_primary_10_1213_ANE_0000000000006867 crossref_primary_10_1097_ALN_0000000000000848 crossref_primary_10_1016_j_ijoa_2015_08_002 crossref_primary_10_1007_s10278_023_00929_3 crossref_primary_10_1016_j_bja_2018_07_034 crossref_primary_10_1111_anae_13167 crossref_primary_10_1111_anae_14898 crossref_primary_10_1097_01_ASM_0001073200_72505_53 crossref_primary_10_1111_acem_12732 crossref_primary_10_12998_wjcc_v11_i9_1951 crossref_primary_10_1007_s11845_021_02530_5 crossref_primary_10_1007_s40140_021_00473_2 crossref_primary_10_1016_j_bja_2018_02_010 crossref_primary_10_3390_diagnostics14060610 crossref_primary_10_3390_medicina60030471 crossref_primary_10_1016_j_tacc_2025_101518 crossref_primary_10_1016_j_jclinane_2016_01_040 crossref_primary_10_1016_j_redare_2018_10_004 crossref_primary_10_1016_j_anclin_2016_09_005 crossref_primary_10_1016_j_pmrj_2013_11_008 crossref_primary_10_1007_s12630_017_0834_z crossref_primary_10_5005_jp_journals_10071_23370 crossref_primary_10_1016_j_ijoa_2013_07_007 crossref_primary_10_1097_AIA_0000000000000456 crossref_primary_10_1093_bja_aex101 crossref_primary_10_1097_ALN_0000000000002454 crossref_primary_10_1111_pan_14451 crossref_primary_10_1186_s40560_016_0174_z crossref_primary_10_1007_s10916_025_02209_9 crossref_primary_10_1111_anae_12735 crossref_primary_10_1016_j_ajem_2019_12_019 crossref_primary_10_1016_j_annfar_2014_01_006 crossref_primary_10_1259_bjr_20130253 crossref_primary_10_1016_j_ajem_2024_08_042 crossref_primary_10_1093_bja_aev417 crossref_primary_10_1111_anae_14354 crossref_primary_10_1111_anae_13665 crossref_primary_10_1007_s00540_018_2538_0 crossref_primary_10_1186_s12871_017_0387_2 crossref_primary_10_1016_j_bja_2017_10_021 crossref_primary_10_1016_j_ijoa_2021_103205 crossref_primary_10_1093_bja_aew192 crossref_primary_10_1016_j_tacc_2023_101211 crossref_primary_10_1016_j_ijoa_2018_06_003 crossref_primary_10_1016_j_bja_2018_11_008 crossref_primary_10_1213_ANE_0000000000006371 crossref_primary_10_1093_bja_aev029 crossref_primary_10_1186_1471_2253_14_108 crossref_primary_10_1097_TA_0b013e31826601e6 crossref_primary_10_7759_cureus_83690 crossref_primary_10_1007_s12630_016_0648_4 crossref_primary_10_1016_j_ecns_2023_101483 crossref_primary_10_1016_j_bjae_2024_09_002 crossref_primary_10_1007_s12630_013_0019_3 crossref_primary_10_1016_j_chest_2019_10_026 crossref_primary_10_1016_j_anclin_2018_09_011 crossref_primary_10_1111_anae_14218 crossref_primary_10_1007_s13665_017_0186_8 crossref_primary_10_3390_jcm11092316 crossref_primary_10_1016_j_resplu_2024_100833 crossref_primary_10_1002_lary_26644 crossref_primary_10_1177_175045891702700902 crossref_primary_10_1213_ANE_0000000000005744 crossref_primary_10_1111_pan_13658 crossref_primary_10_1016_j_joms_2015_06_152 crossref_primary_10_1016_j_bja_2019_03_012 crossref_primary_10_1111_anae_14321 crossref_primary_10_1016_j_jcrc_2020_07_030 crossref_primary_10_1111_aas_13680 crossref_primary_10_1213_ANE_0000000000003604 crossref_primary_10_1186_s12873_023_00796_9 crossref_primary_10_1007_s12630_016_0647_5 crossref_primary_10_1007_s12630_013_9991_x crossref_primary_10_1093_bja_aew176 crossref_primary_10_1111_aas_13169
ContentType	Journal Article
DBID	CGR CUY CVF ECM EIF NPM 7X8
DOI	10.1213/ANE.0b013e31824970ba
DatabaseName	Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic
DatabaseTitle	MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic
DatabaseTitleList	MEDLINE - Academic MEDLINE
Database_xml	– sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database
DeliveryMethod	no_fulltext_linktorsrc
EISSN	1526-7598
ExternalDocumentID	22366848
Genre	Journal Article
GroupedDBID	--- .-D .55 .GJ .XZ .Z2 01R 026 0R~ 1CY 1J1 23M 2WC 3O- 40H 4Q1 4Q2 4Q3 53G 5GY 5RE 5VS 71W 77Y 7O~ AAAAV AAAXR AAGIX AAHPQ AAIQE AAJCS AAMOA AAMTA AAQKA AAQQT AARTV AASCR AASOK AAUEB AAWTL AAXQO ABASU ABBUW ABDIG ABJNI ABKPX ABOCM ABPPZ ABVCZ ABXVJ ABZAD ACCJW ACDDN ACEWG ACGFO ACGFS ACIJW ACILI ACLDA ACLED ACWDW ACWRI ACXJB ACXNZ ADBBV ADFPA ADGGA ADHPY ADNKB AE3 AE6 AEBDS AEETU AENEX AFDTB AFEXH AFFNX AFMFG AFSOK AFUWQ AGINI AHOMT AHQNM AHRYX AHVBC AHXIK AIJEX AINUH AJCLO AJIOK AJNWD AJNYG AJRGT AJZMW AKCTQ AKULP ALKUP ALMA_UNASSIGNED_HOLDINGS ALMTX AMJPA AMKUR AMNEI AOHHW AWKKM BAWUL BOYCO BQLVK BS7 C1A C45 CGR CS3 CUY CVF DIK DIWNM DUNZO E.X E3Z EBS ECM EEVPB EIF EJD ERAAH EX3 F2K F2L F2M F2N F5P FCALG FL- FRP FW0 GNXGY GQDEL GX1 H0~ HLJTE HZ~ IKREB IKYAY IN~ IPNFZ J5H JF9 JG8 JK3 JK8 K8S KD2 KMI L-C L7B M18 MZP N4W N9A NPM N~7 N~B N~M O9- OAG OAH OB4 OCUKA ODA ODMTH OHYEH OJAPA OK1 OL1 OLG OLH OLL OLU OLV OLW OLY OLZ OPUJH ORVUJ OUVQU OVD OVDNE OVIDH OVLEI OVOZU OWBYB OWU OWV OWW OWX OWY OWZ OXXIT P-K P2P PKN PONUX R58 RIG RLZ S4R S4S TEORI TR2 TSPGW V2I VVN W3M W8F WOQ WOW X3V X3W X7M XXN XYM YFH YOC YQJ ZFV ZGI ZXP ZZMQN 7X8 AAFWJ ABPXF ACBKD ACDOF ACZKN ADKSD AFNMH
ID	FETCH-LOGICAL-c3823-7bd32a5f1c415eb69acb0365e3d75e479974db1a302c84b48990afcd460b33112
IEDL.DBID	7X8
ISICitedReferencesCount	116
ISICitedReferencesURI	http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=00000539-201205000-00013&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
ISSN	1526-7598
IngestDate	Sun Nov 09 05:30:15 EST 2025 Wed Feb 19 01:55:33 EST 2025
IsPeerReviewed	true
IsScholarly	true
Issue	5
Language	English
LinkModel	DirectLink
MergedId	FETCHMERGED-LOGICAL-c3823-7bd32a5f1c415eb69acb0365e3d75e479974db1a302c84b48990afcd460b33112
Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
PMID	22366848
PQID	1009128660
PQPubID	23479
ParticipantIDs	proquest_miscellaneous_1009128660 pubmed_primary_22366848
PublicationCentury	2000
PublicationDate	2012-May-01
PublicationDateYYYYMMDD	2012-05-01
PublicationDate_xml	– month: 05 year: 2012 text: 2012-May-01 day: 01
PublicationDecade	2010
PublicationPlace	United States
PublicationPlace_xml	– name: United States
PublicationTitle	Anesthesia and analgesia
PublicationTitleAlternate	Anesth Analg
PublicationYear	2012
References	22523407 - Anesth Analg. 2012 May;114(5):927-8
References_xml	– reference: 22523407 - Anesth Analg. 2012 May;114(5):927-8
SSID	ssj0001086
Score	2.4275672
Snippet	The cricothyroid membrane (CTM) is the recommended site of access to the airway during cricothyroidotomy to provide emergency oxygenation. Despite the apparent...
SourceID	proquest pubmed
SourceType	Aggregation Database Index Database
StartPage	987
SubjectTerms	Adult Body Mass Index Body Weight - physiology Clinical Competence Female Humans Laryngeal Muscles - anatomy & histology Laryngeal Muscles - diagnostic imaging Manikins Membranes - anatomy & histology Mouth - anatomy & histology Neck - anatomy & histology Obesity - pathology Palpation - methods Point-of-Care Systems Reproducibility of Results Snoring - physiopathology Supine Position - physiology Ultrasonography
Title	Accuracy of identification of the cricothyroid membrane in female subjects using palpation: an observational study
URI	https://www.ncbi.nlm.nih.gov/pubmed/22366848 https://www.proquest.com/docview/1009128660
Volume	114
WOSCitedRecordID	wos00000539-201205000-00013&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
hasFullText
inHoldings	1
isFullTextHit
isPrint
link	http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1LS8QwEA7qevDiA1_riwheg90mTVIvsoiLBy17UNhbyVMW3HZtXcF_76TtuidB8NJDoWmSmcx888gMQleM2STcsSZgGySEORsRrbwlUeKldVpH3jcl8x9FlsnJJB13Dre6S6tcysRGUNvSBB85nG7QbLHkPLqdv5PQNSpEV7sWGuuoRwHKBK4Wk1W18NBFqKmXGnMiklR2V-fiAb0eZvcrHyCYICLS6neQ2Sib0c5_p7mLtjuYiYctX-yhNVfso2pozKJS5guXHk9tlyfUkCa8ASiIQYaYQLuqnFo8czOwpQuHpwX2bgaqBNcLHRw3NQ758q94rt7ajOwbrGAM_ePihX83hWsP0Mvo_vnugXQ9F4gJEUEitKWxSvzAgGZ3mqfKaFByiaNWJI6JFOwPqweKRrGRTDMw1yLljWU80pQCeDtEG0VZuGOEmWRKcm1SQTWAMqUMdc4J61OfOmHiPrpcbmEOPB0CFbCkclHnq03so6OWDvm8Lb6RA5zhXDJ58oevT9EW4Ju4zU88Qz0PJ9qdo03z-TGtq4uGWeCZjZ--ASbuy78
linkProvider	ProQuest
openUrl	ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Accuracy+of+identification+of+the+cricothyroid+membrane+in+female+subjects+using+palpation%3A+an+observational+study&rft.jtitle=Anesthesia+and+analgesia&rft.au=Aslani%2C+Anastasia&rft.au=Ng%2C+Su-Cheen&rft.au=Hurley%2C+Michael&rft.au=McCarthy%2C+Kevin+F&rft.date=2012-05-01&rft.issn=1526-7598&rft.eissn=1526-7598&rft.volume=114&rft.issue=5&rft.spage=987&rft_id=info:doi/10.1213%2FANE.0b013e31824970ba&rft.externalDBID=NO_FULL_TEXT
thumbnail_l	http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1526-7598&client=summon
thumbnail_m	http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1526-7598&client=summon
thumbnail_s	http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1526-7598&client=summon