| Surgical airway management | |
|---|---|
 Incricothyrotomy, the incision or puncture is made through thecricothyroid membrane in between thethyroid cartilage and thecricoid cartilage | |
| ICD-9-CM | 31.1-31.3 |
Surgical airway management (bronchotomy[1]) is the medical procedure ensuring an openairway between a patient'slungs and the outside world. Surgical methods for airway management rely on making a surgical incision below theglottis in order to achieve direct access to thelower respiratory tract, bypassing theupper respiratory tract. Surgical airway management is often performed as a last resort in cases where orotracheal and nasotrachealintubation are impossible orcontraindicated. Surgical airway management is also used when a person will need amechanical ventilator for a longer period. The surgical creation of a permanent opening in thelarynx is referred to as laryngostomy.Surgical airway management is a primary consideration inanaesthesia,emergency medicine andintensive care medicine.
Surgical methods for airway management includecricothyrotomy andtracheostomy
Asclepiades of Bithynia is credited with being the first person who proposed bronchotomy as a surgical procedure, though he never attempted to perform one.[2]Aretaeus of Cappadocia thought the procedure dangerous even as a remedy forchoking, since the resulting incision "would not heal, as beingcartilaginous";Caelius Aurelianus also rejected its usefulness.[2]
A cricothyrotomy is an incision made through the skin andcricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body,angioedema, or massive facial trauma.[3] A cricothyrotomy is nearly always performed as a last resort in cases where orotracheal and nasotracheal intubation are impossible or contraindicated. Cricothyrotomy is easier and quicker to perform than tracheotomy, does not require manipulation of the cervical spine and is associated with fewer complications.[4]
A needle cricothyrotomy is similar to a cricothyrotomy, but instead of making a scalpel incision, a large over-the-needle catheter is inserted (10- to 14-gauge). This is considerably simpler, particularly if using specially designed kits. This technique provides very limited airflow. The delivery of oxygen to the lungs through an over-the-needle catheter inserted through the skin into the trachea using a high pressure gas source is considered a form of conventional ventilation calledpercutaneous transtracheal ventilation (PTV).
A tracheotomy is a surgically created opening from the skin of the neck down to the trachea.[5] A tracheotomy may be considered where a person will need to be on a mechanical ventilator for a longer period.[5] The advantages of a tracheotomy include less risk of infection and damage to the trachea such as tracheal stenosis.[5]