What Are the Most Common Surgical Airway Techniques?

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

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. 

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

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.

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)