Quick overview of the surgical cricothyroidotomy technique as presented in the 2015 Difficult Airway Society guidelines. This is simply presenting the technique in a manikin model, not intended as a debate about the relative merits of needle vs. surgical, blade vs. hook, scalpel-finger-bougie vs. scalpel-bougie-tube, etc!
Don’t forget to wear your PPE (gloves, mask, eye protection) and appropriately secure the tube afterwards.
As always, constructive criticism and suggestions for improvement are always welcomed in the comments section.
Lots of ensuing discussion of the ideal angle of puncture of the cricothyroid membrane. 90 degrees (perpendicular to skin) has least risk of puncturing posterior wall of the trachea, but greatest risk of cannula kinking. I advocate around 60 degrees for puncture and then decreasing angle to advance cannula:
Click the image to go to the article on Anesthesiology News
This month’s edition of Anesthesiology News features a worthwhile piece from Prof John Doyle, in which he poses 7 questions on the current state of airway management to 6 airway experts from around the world (Abdelmalak, Cooper, Frova, Rosenblatt, Spiegel and Doyle himself), and collates their responses into a dialogue. Definitely worth reading to determine what some (certainly not all) of the biggest names in the world are thinking on:
For what it is worth, here are my own answers, distilled into one-liners. I’m very willing to enter into discussions about them!
Place for DL in the future: Definitely; just look at the huge needs in the Third World and then ask if (even very cheap) VLs are a priority.
Use of bougies: Along with good positioning and mastery of face-mask skills, I think this is one of the most neglected parts of airway training.
What airway algorithm: The expert can do what they wish; the trainee should learn something appropriate (like ASA or DAS); the infrequent practitioner should use the Vortex.
Trache vs Cric: Cric all the way; scalpel-finger-bougie
Impact of VL in AFOI: Definitely reducing the use of AFOI, but a flexible scope remains an essential tool, and every airway master should be competent in it’s use.
Favourite SGA: Would love to say the 3gLM, but we need to publish the research first…
Favourite VL: Hasn’t been invented yet, but watch this space. The C-MAC with Pocket Monitor is my daily workhorse, but I have (and use) GlideScope, McGrath, AirTraq, King Vision, etc.
There are a lot of excellent (and complementary) views expressed in the article, which are worth reading. Check it out!
Open access meducation for all aspects of airway management
