Articles: thyroid-cartilage-surgery.
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Randomized Controlled Trial Comparative Study
Surgical vs wire-guided cricothyroidotomy: a randomised crossover study of cuffed and uncuffed tracheal tube insertion.
Using an airway mannequin and artificial lung model, we compared surgical cricothyroidotomy with a 6.0-mm cuffed Portex tracheostomy tube with wire-guided cricothyroidotomy using a 5.0-mm cuffed Melker or 6.0-mm uncuffed Melker tube. The trial was carried out by 27 anaesthetists using a randomised, crossover design. Surgical cricothyroidotomy proved significantly faster (mean (SD) time to first breath 44.3 (12.5) s for Portex surgical, 87.2 (21.6) s for cuffed Melker, 87.8 (19.2) s for uncuffed Melker, p < 0.001). ⋯ Fourteen of the participants preferred the wire-guided system. We conclude that, in this model, a cuffed device is preferable when cricothyroidotomy is needed. In addition, the surgical method is quicker than a wire-guided approach.
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Randomized Controlled Trial Comparative Study Clinical Trial
Safety and efficacy of the Rapid Four-Step Technique for cricothyrotomy using a Bair Claw.
The Rapid Four-Step Technique (RFST) has been demonstrated to be faster than standard open crico thyrotomy technique, but may have a higher incidence of cricoid injury with tracheal hook traction applied caudad. The "Bair Claw" is a novel device that may help eliminate these complications. This randomized, experimental trial used a fresh-frozen cadaver model of cricothyrotomy to compare speed and safety between RFST using a Bair Claw and standard open technique. ⋯ There was no significant difference with regard to size of ET tube able to be passed with RFST using a Bair Claw versus standard open technique, and there was no damage to trachea or larynx observed with either technique. We concluded that RFST using a Bair Claw is faster and appears to be equally safe when compared to standard open technique in a fresh-frozen cadaver model of cricothyrotomy. The two techniques were equal with regard to maximal ET tube size.
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Randomized Controlled Trial Clinical Trial
Use of the Trousseau dilator in cricothyrotomy.
When performing cricothyrotomy, once the initial incision has been created, the scalpel handle may be inserted into the incision and rotated, or a Trousseau dilator may be used to widen the opening. During endotracheal (ET) tube passage, the Trousseau dilator may be left in place or a tracheal hook may be inserted for tracheal stabilization. This experimental crossover trial of cricothyrotomy in a cadaver model compared: 1) scalpel handle rotation to the use of a Trousseau dilator in widening the initial incision, and 2) the use of a tracheal hook to a Trousseau dilator during ET tube passage. ⋯ We found that the average size of the largest ET tube passed was significantly greater with the use of a tracheal hook (internal diameter mean 7.0 mm, median 7.0 mm) than with a Trousseau dilator (internal diameter mean 5.7 mm, median 5.5 mm). There was no damage to local tissue and no cuff ruptures. We conclude that the scalpel handle rotation technique is equal to the use of the Trousseau dilator with regard to opening size and maximal ET tube size but that use of a tracheal hook rather than a Trousseau dilator allows for passage of a larger ET tube in a cadaver model of cricothyrotomy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of 2 cricothyrotomy techniques: standard method versus rapid 4-step technique.
To compare the success rate, complication rate and time required for the rapid 4-step technique versus the standard technique for cricothyrotomy. ⋯ In a group of inexperienced subjects working on a preserved human cadaver model, the rapid 4-step technique for cricothyrotomy was performed in about one third the time required for performance of the standard technique. This finding was both clinically and statistically significant. Although the 2 techniques had similar success and complication rates, we noted a trend toward more severe complications in the rapid 4-step technique.