Surgical Airway

Abstract

Close to 3% of all intubation attempts are considered difficult airways, for which a plan for a surgical airway should be considered. Our article provides an overview of the different types of surgical airways. This article provides a comprehensive review of the main types of surgical airways, relevant anatomy, necessary equipment, indications and contraindications, preparation and positioning, technique, complications, and tips for management. It is important to remember that the placement of a surgical airway is a lifesaving procedure and should be considered in any setting when one “cannot intubate, cannot ventilate”.

Prehospital tracheotomy in a case of avulsion of the larynx with a comminuted fracture of the jawbone

“…Fractures of the larynx are rare injuries with an incidence rate of one in 30,000 because the larynx is relatively protected by the sternum and the mandible [1-4]. Typically, the massive traumatic impact required to cause laryngeal fracture usually results in additional injuries such as midfacial fractures, fractures of the body of cervical vertebra, and craniocerebral trauma; in addition, the patients commonly develop pneumothorax [2,4,5]. Overall, the patient population shows a high rate of mortality [2,4].…”

“…Moreover, in some cases, cricothyrotomy, the method of choice for securing an emergency airway may not have a successful outcome. In the literature, few cases of prehospital tracheotomy have been reported previously [1-5].…”

Adverse outcomes after percutaneous dilatational tracheostomy versus surgical tracheostomy in intensive care patients: case series and literature review

“… 2 , 3 Possible difficulties with intubation due to edema, tumor on the face or neck or other known anatomical abnormalities and dysmorphies may be an indication to perform a tracheostomy. 4 Considering the above-mentioned indications, there are no absolute contraindications to perform this procedure. Relative contraindications include coagulopathy, difficult anatomy (eg, tracheal deviation and vascular abnormalities), narrowing or obstruction in bronchial tree, recent cervical spine surgery or unstable fractures of cervical spine and local neck infection.…”

“…Relative contraindications for percutaneous dilatational tracheostomy (PDT) are small children, patients with short thick neck, anatomical abnormalities or high bifurcation of the brachiocephalic trunk. 4 Throughout the years, tracheostomy technique evolved from surgical open tracheostomy, but thanks to the evolution of equipment and doctors skills, tracheotomy has became a less invasive procedure which can be simply done at the bedside. 6 The number of performed percutaneous tracheostomies in the ICU is still increasing.…”

Tracheostomy in Hair Dye Poisoning - Indications and Clinical Outcome

“…Airway may also be maintained by endotracheal intubation and some centers use prophylactic intubation even before development of edema. [5] Aim To determine the criteria for managing airway by tracheostomy in patients with hair dye poisoning.…”