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

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

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

Conditions
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Aspiration Pneumonia

Intervention / Treatment
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* Procedure: Cricoid pressure
* Device: Ultrasound


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cricoid Cartilage localization<br>The caregiver will be asked to palpate the cricoid cartilage and draw aline where he will apply cricoid pressure during rapid sequence induction | Procedure: Cricoid pressure<br>* participants will ask to mark the place where they will apply cricoid pressure if the patients was undergoing rapid sequence induction. US will be used to confirm how accurate they are in their estimation.<br>* Other names: Sellick's Maneuver;Device: Ultrasound<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Distance between measured Cricoid cartilage (by Assessors) and Ultrasound |  | 10 minutes | 
| The level of difficulty to locate Cricoid cartilage NRS score |  | 10 minutes | 
| Total time required for assessment |  | 10 seconds | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cricoid cartilage, cricoid pressure, obstetric