FORMAL CRICOTHYROIDOTOMY (SURGICAL)

TECHNIQUE

• Identify the caricatured membrane as above
• Infiltrate with local anesthetic using 1% linking with adrenaline
• Using the scalpel make a vertical incision through the skin and down to the membrane
• Make a horizontal incision through the caricatured membrane at its junction with the cricked cartilage
• Use the forceps and scissors to open the aperture and pass the tube into the trachea
• Remove the forceps, inflate the cuff and anchor the tube
• Arrange a CXR

COMPLICATIONS

• Mal position

              subcutaneous emphysema

              injury to nearby structures (as above)

• Hemorrhage
• Failure and resultant asphyxia
• Infection

ADVANTAGES

• Provides a definitive and stable airway
• Simpler and safer than a tracheotomy
• Rapid

DISADVANTAGES

• Landmarks are often difficult in the clinical settings in which it is needed
• Needs some surgical skill
• Is not recommended in a child <12 years
• Sliding sets are expensive