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Thyromental distance (TMD) measurement is commonly used to predict difficult intubation. We surveyed anaesthetists to determine how this test was being performed. Comparative accuracy of ruler measurement and other forms of measurement were also assessed in a meta-analysis of published literature. Of respondents, 72% used fingers for TMD measurement and also considered three finger widths the minimum acceptable TMD. In terms of distance, the minimum acceptable TMD was felt to be 6.5 cm by 55% of respondents. However, the actual width of three fingers was (range) 4.6-7.0 cm (mean 5.9 cm), with significant differences between genders and between proximal and distal interphalangeal joints. The meta-analysis showed ruler measurement increased test sensitivity (48% (95% CI 43-53) vs 16% (95% CI 14-19) without a ruler), when predicting difficult intubation.

Two- and three-dimensional laboratory experiments were conducted in a large 1 by 1 m 2 Hele–Shaw cell and a 10-cm cylinder column to study the stability of the redistribution process in a uniformly packed porous medium of coarse sand. Our results demonstrate that fingers form and propagate rapidly as soon as infiltration stops when the soil is initially dry, but form more slowly and are larger when the soil is wet. Finger widths ranged from about 4.5 cm when the soil was dry to 17 cm when the soil was very wet, and the fraction of the cross-sectional area occupied by fingers also increased (from 36 to 66%). Finger velocities declined with time in all studies, with averages ranging from 3.6 to 9.6 cm min −1 . We demonstrated that ponded infiltration was stable and uniform in our system, so that the fingering we observed was not due to soil heterogeneity. The porous medium retained a memory of the fingers formed in the first experiment, so fingers formed in subsequent redistribution cycles followed the old finger paths, even after 28 d had elapsed. Fingers provide channels for rapid drainage of previously infiltrated water, especially when the soil ahead of the front is dry. Our findings clearly contradict predictions made by the Richards equation, which calculates stable flow during redistribution in homogeneous soil.