Articles: thyroid-cartilage-surgery.
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Comparative Study
Comparison of three cuffed emergency percutaneous cricothyroidotomy devices to conventional surgical cricothyroidotomy in a porcine model.
Emergency cricothyroidotomy is a potentially life-saving procedure in the 'cannot intubate cannot ventilate (CICV)' scenario. Although surgical cricothyroidotomy remains the technique recommended in many 'CICV' algorithms, the insertion of a tracheostomy as a cannula over a trocar, or using the Seldinger method, may have advantages as they are more familiar to the anaesthetist. We compared the utility of three cuffed cricothyroidotomy devices: cuffed Melker®, Quicktrach 2®, and PCK® devices, with surgical cricothyroidotomy. ⋯ The Melker® and Quicktrach 2® devices appear to hold particular promise as alternatives to surgical cricothyroidotomy. Further studies, in more clinically relevant models, are required to confirm these initial positive findings.
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Letter Case Reports
Laryngospasm in an unsedated patient during elective cannula cricothyroidotomy.
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Cannula cricothyroidotomy is recommended for emergency transtracheal ventilation by all current airway guidelines. Success with this technique depends on the accurate and rapid identification of percutaneous anatomical landmarks. Six healthy subjects underwent neck ultrasound to delineate the borders of the cricothyroid membrane. ⋯ Consultant and registrar anaesthetists were significantly more accurate than senior house officers at correctly identifying the cricothyroid membrane. Accuracy of percutaneously identifying the cricothyroid membrane was poor. Ultrasound may assist in identifying anatomical landmarks for cricothyroidotomy.
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The difficult intubation is one of the most trying situations encountered in airway management. Transtracheal jet ventilation via needle cricothyroidotomy can provide temporary oxygenation in this critical situation in a minimally invasive fashion. ⋯ The incorporation of EDDs in i.v. catheter placement for needle cricothyroidotomy is shown to be effective and merits further study. Likewise, further investigation is needed to identify a standardized apparatus for needle cricothyroidotomy in emergent situations.
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The objective was to compare time to completion, failure rate, and subjective difficulty of a new cricothyrotomy technique to the standard technique. The new bougie-assisted cricothyrotomy technique (BACT) is similar to the rapid four-step technique (RFST), but a bougie and endotracheal tube are inserted rather than a Shiley tracheostomy tube. ⋯ This study demonstrates that the BACT is faster than the standard technique and has a similar failure rate when performed by inexperienced providers on anesthetized sheep.