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Background: Large neck circumference and displacement of the trachea due to pathology increase the risk of failed identification of the cricothyroid membrane and cricothyroidotomy. We investigated whether ultrasound aids in the successful identification of the cricothyroid membrane in a model of an obese neck with midline deviation of the trachea., Methods: We developed silicone neck models that were suitable for both palpation and ultrasonography and where the trachea deviated laterally from the midline to either side. After reading a book chapter and participating in a 25-minute lecture and a 15- to 23-minute hands-on demonstration and rehearsal of ultrasonography for identification of the cricothyroid membrane, anesthesiologists and anesthesiology residents randomly performed identification with either ultrasound or palpation on 1 of 2 neck models., Results: We included 57 participants, of whom 29 and 28 were randomized to palpation and ultrasound, respectively. Correct identification of the cricothyroid membrane was achieved by 21 (75.0%) vs 1 (3.5%) of participants in the ultrasound versus palpation groups (risk ratio [RR], 21.8 [95% confidence interval {CI}, 3.1-151.0]). The tracheal midline position in the sagittal plane was identified correctly by 24 (85.7%) vs 16 (55.2%) of participants in the ultrasound versus palpation groups (RR, 1.6 [95% CI, 1.1-2.2])., Conclusions: Identification of the cricothyroid membrane in a model of an obese neck with midline deviation of the trachea was more often successful with ultrasound compared to palpation. Our study supports the potential use of ultrasound before induction of anesthesia and airway management in this group of patients, and it may even be applied in emergency situations when ultrasound is readily available. Further studies in human subjects should be conducted., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

The fact of reasonable pluralism in liberal democracies threatens the stability of such societies. John Rawls proposed a solution to this problem: The different comprehensive moral doctrines endorsed by the citizens overlap on a shared political conception of justice, e.g. his justice as fairness. Optimally, accepting the political conception is for each citizen individually justified by the method of wide reflective equilibrium. If this holds, society is in full reflective equilibrium. Rawls does not in detail investigate the conditions under which a full reflective equilibrium is possible or likely. This paper outlines a new strategy for addressing this open question by using the formal model of reflective equilibrium recently developed by Beisbart et al. First, it is argued that a bounded rationality perspective is appropriate which requires certain changes in the model. Second, the paper rephrases the open question about Rawlsian full reflective equilibrium in terms of the model. The question is narrowed down by focusing on the inferential connections between comprehensive doctrines and political conception. Rawls himself makes a demanding assumption about which connections are necessary for a full reflective equilibrium. Third, the paper presents a simulation study design that is focused on simplicity. The results are discussed, they fit with Rawls's assumption. However, because of the strong idealisations, they provide a useful benchmark rather than a final answer. The paper presents suggestions for more elaborate study designs., Competing Interests: Conflict of interestThe author has no relevant financial or non-financial interests to disclose., (© The Author(s) 2023.)