Surgical cricothyroidotomy and the changing role of the anaesthetist in the emergency management of a suspected difficult airway

Surgical cricothyroidotomy and the changing role of the anaesthetist in the emergency management of a suspected difficult airway

Published: 15 Aug 2018

© Anaesthesia Cases / 2018-0114 / ISSN 2396-8397

Authors

Dr Andrew Wood [1]
Dr Valerie Lan-Pak-Kee [2]
Dr Madeleine Dancey [3]
Dr Seema Shah [3]
  • [1] Specialty Registrar, Anaesthesia, The Royal London Hospital, Barts NHS , London, United Kingdom
  • [2] Core Trainee, Anaesthesia , The Royal London Hospital, Barts Health NHS, London, United Kingdom
  • [3] Consultant, Anaesthesia, The Royal London Hospital, Barts Health NHS, London, United Kingdom

Summary

An emergency surgical cricothyroidotomy was successfully performed as the primary airway intervention on a 66-year-old patient who presented to our hospital with severe respiratory compromise due to upper airway obstruction. The history included recent surgery to resect a mandibular tumour invading the base of the tongue. The clinical evidence available suggested that laryngoscopy and tracheal intubation would be difficult, time-consuming and potentially futile. In contrast, the external anatomy suggested that cricothyrotomy would be relatively straightforward. Consequently, it was decided that primary front-of-neck access performed by the anaesthetist, who had been trained to perform this technique for the management of a can’t intubate can’t oxygenate scenario, would be the fastest and most reliable way to achieve adequate gas exchange. There is evidence to support this strategy in emergency situations.

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