- Cricothyroidotomy
- Indications
- Anticipated difficult airway (elective)
- Elective provision of oxygenation (+/- ventilation) by sub glottis route
- CICV
- LA to cords for AFOI
- Equipment
- Small cannulae (2-3mm internal diameter)
- Require high pressure O₂ supply eg Sander's or VBM manujet to overcome resistance. Passive exhalation of 500ml takes about 4s so frequency is limited to 10-12 bpm.
- Large bore (4mm or greater id) for oxygenation and ventilation (Portex, Cook, VBM)
- Surgical Cricothyroidotomy (6mm or greater)
- The cricothyroid membrane is a yellow connective tissue 8mm deep to the skin, 9mm high and 30mm wide. The true vocal cords are usually 10mm or more above
- The superior cricothyroid artery may cross above the upper 1/3 of the membrane. Venous haemorrhage is possible even with a midline approach.
- Complications
- Early
- Bleeding
- Unsuccessful placement
- Posterior wall perforation
- Pneumothorax
- Airway obstruction
- Vocal cord injury
- Aspiration
- Laryngeal cartilage fracture
- Oesophageal/mediastinal puncture
- Late
- Aspiration
- Subglottic stenosis
- Swallowing dysfunction
- TOF
- Voice change
- Infection
- Late bleeding
- Stoma
- Tracheomalacea
- CEACCP
Link:ceaccp.oxfordjournals.org/content/early/2008/08/22/bjaceaccp.mkn029.full.pdf