Clinical implications of Vocal Cord-Carina Distance and Tracheal Length in the Indian Population [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Ahead of Print: TARD-20856

Clinical implications of Vocal Cord-Carina Distance and Tracheal Length in the Indian Population

Shashi Kumari, Smita Prakash, Parul Mullick, Sushil Guria, Kiran Kumar Girdhar
Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

Objective: Securing the tracheal tube (TT) at a fixed recommended depth of 21/23 cm in females and males, respectively, may result in inappropriate placement of the TT in some patients. We determined the vocal cord-carina distance (VCD) and tracheal length (TL) to ascertain the optimal depth of TT placement during orotracheal intubation in adult Indian population.
Methods: We studied 92 adults undergoing elective surgery under general anaesthesia with orotracheal intubation. Surface anatomy airway measurements were noted. A cuffed TT (females size 7, males size 8 mm ID) was inserted with the intubation guide mark at level with the vocal cords (VC). Fibreoptic bronchoscopy-guided measurements were obtained for VCD, TL, TT tip-carina, VC-cricoid and lip-carina (L-C) distance.
Results: The (mean±SD) VCD was (12.82±2.05 and12.02±1.44 cm) and TL (10.14±2.04 and 9.37±1.28 cm ) in males and females, respectively. Statistically significant differences were observed between males and females in VCD (P=0.033); TL (P=0.032); L-C distance (P<0.001) and lip-TT tip distance (P<0.001); Lip-TT tip distance was 19.50±1.39 cm in males and 18.17±1.28 cm in females. The L-C distance correlated with patient height, weight and neck length. L – C distance = 7.214 + 0.049 x height + 0.320 x neck length + 0.033 x weight.
Conclusion: We recommend placing the TT tube with its proximal guide mark at the level of vocal cords in the Indian population. The 21/23 cm rule for tube placement depth in females and males, respectively, cannot be routinely followed in the Indian population.

Keywords: vocal cord-carina distance, tracheal length, tracheal intubation, tracheal tube, fibreoptic bronchoscope




Corresponding Author: Smita Prakash, India


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