- Morbid obesity and/or short neck with inability to identify and palpate trachea
- Vascular structures such as a high-riding innominate or thyroid internal mammary artery (on palpation or ultrasound)
- Gross distortion of the neck from hematoma, tumor, thyromegaly, or scarring
- Severe tracheomalacia with cartilage destruction
- Inability to safely extend the neck (eg, cervical fusion, rheumatoid arthritis, or other causes of cervical spine instability)Δ
- Prior complex tracheal surgery (eg, tracheoplasty, tracheal resection, and reconstruction; previous tracheostomy is not a contraindication)
- Children <15 years
- Patients requiring emergency airway◊
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