Abstract
Background: Several case reports have described anatomical variations that can cause difficulty with front-of-neck airway access, such as major vessels anterior to the trachea. The prevalence of these anomalies is unknown. Methods: We screened 500 consecutive thoracic computed tomography (CT) scans in adult patients performed independently in any public hospital in Western Australia. The prevalence of major vessels anterior to the trachea in the anterior triangle of the neck was determined. Results: In the suprasternal notch, 264 CT scans (53%) demonstrated part of a major vessel anterior to the trachea, most commonly the brachiocephalic artery. At 10, 20, and 30 mm above the suprasternal notch, respectively, 126 (25%), 48 (9%), and 5 (1%) CT scans showed a major vessel anterior to the trachea. None showed a major vessel anterior to the cricothyroid membrane. In the suprasternal notch, a major vessel was anterior to the trachea in 10 of 120 CT scans (8%) that had a manubrio-cricoid distance <25 mm, and 108 of 116 CT scans (93%) that had a manubrio-cricoid distance >50 mm. In a logistic-regression model, increased length of trachea above the manubrium was a strong predictor of major vessels anterior to the trachea in the suprasternal notch, whilst sex, age, thoracic kyphosis, tracheal diameter, and the origin of the brachiocephalic artery were not strong predictors. Conclusions: It is common for patients to have some portion of a major vessel anterior to the trachea at sites where an emergency tracheostomy might be performed.
| Original language | English |
|---|---|
| Pages (from-to) | 1166-1172 |
| Number of pages | 7 |
| Journal | British Journal of Anaesthesia |
| Volume | 121 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 1 Nov 2018 |
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Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults. / Weightman, W. M.; Gibbs, N. M.
In: British Journal of Anaesthesia, Vol. 121, No. 5, 01.11.2018, p. 1166-1172.Research output: Contribution to journal › Article
TY - JOUR
T1 - Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults
AU - Weightman, W. M.
AU - Gibbs, N. M.
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Background: Several case reports have described anatomical variations that can cause difficulty with front-of-neck airway access, such as major vessels anterior to the trachea. The prevalence of these anomalies is unknown. Methods: We screened 500 consecutive thoracic computed tomography (CT) scans in adult patients performed independently in any public hospital in Western Australia. The prevalence of major vessels anterior to the trachea in the anterior triangle of the neck was determined. Results: In the suprasternal notch, 264 CT scans (53%) demonstrated part of a major vessel anterior to the trachea, most commonly the brachiocephalic artery. At 10, 20, and 30 mm above the suprasternal notch, respectively, 126 (25%), 48 (9%), and 5 (1%) CT scans showed a major vessel anterior to the trachea. None showed a major vessel anterior to the cricothyroid membrane. In the suprasternal notch, a major vessel was anterior to the trachea in 10 of 120 CT scans (8%) that had a manubrio-cricoid distance <25 mm, and 108 of 116 CT scans (93%) that had a manubrio-cricoid distance >50 mm. In a logistic-regression model, increased length of trachea above the manubrium was a strong predictor of major vessels anterior to the trachea in the suprasternal notch, whilst sex, age, thoracic kyphosis, tracheal diameter, and the origin of the brachiocephalic artery were not strong predictors. Conclusions: It is common for patients to have some portion of a major vessel anterior to the trachea at sites where an emergency tracheostomy might be performed.
AB - Background: Several case reports have described anatomical variations that can cause difficulty with front-of-neck airway access, such as major vessels anterior to the trachea. The prevalence of these anomalies is unknown. Methods: We screened 500 consecutive thoracic computed tomography (CT) scans in adult patients performed independently in any public hospital in Western Australia. The prevalence of major vessels anterior to the trachea in the anterior triangle of the neck was determined. Results: In the suprasternal notch, 264 CT scans (53%) demonstrated part of a major vessel anterior to the trachea, most commonly the brachiocephalic artery. At 10, 20, and 30 mm above the suprasternal notch, respectively, 126 (25%), 48 (9%), and 5 (1%) CT scans showed a major vessel anterior to the trachea. None showed a major vessel anterior to the cricothyroid membrane. In the suprasternal notch, a major vessel was anterior to the trachea in 10 of 120 CT scans (8%) that had a manubrio-cricoid distance <25 mm, and 108 of 116 CT scans (93%) that had a manubrio-cricoid distance >50 mm. In a logistic-regression model, increased length of trachea above the manubrium was a strong predictor of major vessels anterior to the trachea in the suprasternal notch, whilst sex, age, thoracic kyphosis, tracheal diameter, and the origin of the brachiocephalic artery were not strong predictors. Conclusions: It is common for patients to have some portion of a major vessel anterior to the trachea at sites where an emergency tracheostomy might be performed.
KW - brachiocephalic trunk
KW - brachiocephalic veins
KW - emergency treatment
KW - suprasternal notch
KW - tracheostomy
UR - http://www.scopus.com/inward/record.url?scp=85051751545&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2018.07.013
DO - 10.1016/j.bja.2018.07.013
M3 - Article
VL - 121
SP - 1166
EP - 1172
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
SN - 0007-0912
IS - 5
ER -