What is surgical airway management?
Surgical airway management involves the creation of an airway using surgical techniques. Surgical airway management is often performed
- In unstable patients
- In case of stable patients who cannot be intubated or ventilated
What are the most common surgical airway techniques?
The four distinct but related most common surgical airway techniques include the following:
- Open cricothyroidotomy
- Needle cricothyroidotomy with jet oxygenation
- Percutaneous cricothyroidotomy using the Seldinger technique
- Surgical tracheostomy (an incision in the windpipe made to relieve an obstruction to breathing)
Cricothyroid is a small, two-sided membrane found in the neck (Adam’s apple). Mostly, cricothyrotomy is preferred over tracheostomy because of its ease, speed, and lower complication rate.
For children younger than 12 years, needle cricothyroidotomy is the preferred choice of surgical airway management.
When should be surgical airway management avoided?
Surgical airway management should be avoided in patients in the following conditions:
- Previous neck surgery
- Disrupted airway
- Previous radiation therapy
- Tumors in the larynx or trachea
- Obesity
- Blood clot or pus accumulation in the neck
- Presence of a short neck
How is surgical airway management performed?
The different surgical airway management has been explained below:
Open cricothyroidotomy
- The patient is made to lie flat on the table.
- The physician then cleans the patient’s neck using antiseptic swabs and applies local anesthesia to the neck.
- The physician then locates the cricothyroid membrane.
- Next, the physician makes an incision through the skin.
- The physician then inserts a tracheal hook through the opening and hooks the tail end of the opening.
- The physician then lifts the opening and inserts a tube with a cuff attached.
- The physician inflates the cuff and checks for chest rise.
- Finally, the physician secures the airway.
Needle cricothyroidotomy
- In this technique, the physician penetrates the site with a needle.
- An incision can be made to direct the needle.
- A needle is used to aspirate the air to check if the air can enter the syringe from the tracheal tree.
- The physician passes a catheter (tube) over the needle.
Percutaneous cricothyroidotomy (Seldinger technique)
- This technique is similar to needle cricothyroidotomy, but with certain modifications.
- After inserting the needle, the physician advances the guidewire through the syringe toward the airway.
- Before removing the needle, the physician enlarges the opening to insert a dilator airway tube device over the guidewire.
- Once the airway device is in place, the physician removes the dilator and guidewire.
What are the complications of surgical airway management?
The complications of different techniques are stated below.
Open cricothyroidotomy:
- Aspiration (inhalation of foreign materials into the lungs)
- Bleeding
- Blood clots
- Esophagus or trachea tear
- Injury to the voice cord
- Mediastinum emphysema (trapped surrounding the heart and central blood vessels)
- Narrowing of the larynx
- Creation of false passage into the adjacent tissue
Needle cricothyroidotomy:
- Inadequate ventilation
- Aspiration (inhalation of blood into the lungs)
- Esophagus tear
- Hole in the wall of the trachea
- Hole in the thyroid
- Hypercarbia (excess amount of oxygen in the bloodstream)
- Subcutaneous emphysema (trapped air in the tissue beneath the skin)
![](https://images.medicinenet.com//images/slideshow/8-first-aid-essentials-for-car-or-purse-s1-photo-of-tweezers-used-to-remove-splinter.jpg)
SLIDESHOW
8 First Aid Kit Essentials for Scrapes, Cuts, Bug Bites, and More See SlideshowHealth Solutions From Our Sponsors
Medscape Medical Reference
Top The Most Common Surgical Airway Techniques Related Articles
Airway Picture
The path air follows to get into and out of the lungs. See a picture of Airway and learn more about the health topic.What Are the Different Types of Mechanical Ventilation?
Mechanical ventilation is a treatment to help a person breathe when they find it difficult or are unable to breathe on their own. A mechanical ventilator pushes airflow into the patient’s lungs. Mechanical ventilation is part of the arsenal of supportive care clinicians use for COVID-19 coronavirus disease patients with the most severe lung symptoms.Emergency Preparedness: Staying Safe in Winter Weather
Emergency preparedness helps you stay safe during and after an emergency. Emergency preparedness kits are available, and checklists can help ensure you have the right supplies on hand. An emergency preparedness plan can help you be safe when wild winter weather hits.First Aid: Why You Need a First Aid Kit and CPR
First aid is providing medical assistance to someone a sick or injured person. The type of first aid depends on their condition. Preparedness is key to first aid, like having basic medical emergency kits in your home, car, boat, or RV. Many minor injuries may require first aid, including cuts, puncture wounds, sprains, strains, and nosebleeds. Examples of more critical first aid emergencies include heart attacks, strokes, seizures, and heatstroke.Extreme Heat Emergency
Too much heat can make you tired, sick, and woozy. WebMD guides you through these and other things heat can do to your body and what to do about it.Nasal Airway Surgery (Septoplasty)
Deviated septum surgery (septoplasty) and turbinectomy (nasal airway surgery) is performed on individuals who have a deviated or crooked septum or enlarged tissues (turbinates) within the nose. The goal of surgery is to improve breathing, control nosebleeds, relieve sinus headaches, and promote drainage of the sinus cavities. Risks and complications of surgery should be discussed with the surgeon prior to surgery.Tracheostomy
A tracheostomy is a surgical procedure that creates an opening in the neck leading directly to the trachea (the breathing tube). It is kept open with a hollow tube called a tracheostomy tube. Tracheostomies are used to bypass an obstructed airway, remove airway secretions, and deliver oxygen to the lungs. Tracheostomy care after the procedure will include suctioning of the trachea, and changing and cleaning the tube.Trauma/First Aid Quiz
What should be in your first-aid kit? Take this quiz to understand trauma and learn the truth about how to administer first aid.What Are the Types of Noninvasive Ventilation?
A ventilator is a machine that helps in delivering oxygen to your lungs. It is used to assist with breathing when you cannot breathe on your own. There are two types of ventilation includes invasive ventilation and noninvasive ventilation.What Is a Laryngeal Mask Airway (LMA) Used For?
A laryngeal mask airway (LMA) is a device inserted into the area behind the mouth and nose, connecting them to the food pipe (the pharynx) to allow ventilation, oxygenation, and administration of anesthetic gases, without the need for inserting a tube in the windpipe (endotracheal intubation). It was initially used mainly in an operating room setting, but is also used in the emergency setting. Complications include aspiration of stomach contents, local irritation, upper airway injuries, mild sympathetic response, obstruction, laryngospasm, pulmonary edema, and bronchoconstriction.What Is an Eucapnic Hyperventilation (EVH) Test?
Eucapnic voluntary hyperventilation (EVH) is a provocative test to diagnose exercise-induced airway narrowing (exercise-induced bronchospasm). Eucapnic voluntary hyperventilation (EVH) is usually done for individuals in occupations in which asthma needs to be excluded, professional athletes, and young active-duty soldiers in the military.What Is Bag Valve Mask Ventilation (BVM) Used For?
Bag-valve-mask (BVM) or the Ambu bag is a self-inflating bag used to provide ventilation to the person not breathing normally. BVM ventilation is a critical skill for emergency providers. BVM ventilation is a technique that restores breathing in patients who are not spontaneously breathing. BVM ventilation is indicated in the respiratory (lung) failure, failed intubation (insertion of an artificial ventilation tube into the trachea), patients undergoing anesthesia for elective surgery, and apnea (slowed or stopped breathing).What Is Barotrauma in Mechanical Ventilation?
Barotrauma is a condition in which the alveoli (air sacs of the lungs) rupture with a subsequent entry of air into the surrounding extra alveolar space. Barotrauma mainly occurs either due to the rupture of the air sacs (alveolus) of lungs or a direct injury. Alveolar rupture can be either ventilator-related or disease-related. Ventilator-related causes include Positive pressure ventilation and Elevated pressure. Disease-related causes include asthma, chronic obstructive pulmonary disease (COPD), chronic interstitial lung disease, and acute respiratory distress syndrome.When Should a Tracheostomy Tube Be Changed?
A tracheostomy is an opening that surgeons make through the front of the neck and into the windpipe (trachea). The tracheostomy tube is placed into the opening to keep it open for breathing when the usual route for breathing is somehow blocked or reduced. When health problems require long-term use of a machine (ventilator) to help breathe, a tracheostomy is often needed. In rare cases, an emergency tracheostomy is performed when the airway is suddenly blocked, such as after a severe injury to the face or neck.