Articles: thyroid-cartilage-surgery.
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Ann Oto Rhinol Laryn · Jul 1982
Cricothyroidotomy: the impact of antecedent endotracheal intubation.
In light of the current debate regarding cricothyroidotomy, we elected to study the procedure at our institution. Cricothyroidotomy was instituted whenever tracheotomy was necessary for airway management. After a fairly short period of time, some significant complications of cricothyroidotomy were apparent and the study was aborted prior to achieving statistically significant results. ⋯ The major underlying factor in patients who developed complications was prolonged intubation prior to the institution of cricothyroidotomy. The study suggests that cricothyroidotomy should not be performed after prolonged intubation. The issue of primary cricothyroidotomy for short-term airway control remains unanswered.
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Critical care medicine · Jun 1982
Elective cricothyroidotomy: a clinical and histopathological study.
Elective cricothyroidotomy was carried out on 61 adult patients in the ICU between June 1977 and October 1980. This procedure replaced elective tracheotomy in those patients who were judged to require respirator treatment for a period longer than 72 h. Twenty-six of the patients were examined by the ENT department. ⋯ Contraindications to cricothyroidotomy are endotracheal intubation for a period longer than 72 h, respiratory difficulties after previous endotracheal intubation, and acute infections of the larynx. Cricothyroidotomy is faster and much easier than tracheotomy. The authors believe that every doctor who works in intensive care should be able to carry out this procedure.
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Analysis of the case histories of 17 patients who developed subglottic obstruction following cricothyroidotomy shows that all 10 patients with chronic stenosis had acute laryngeal pathology at the time of initial operation. Seven patients were identified as having acute subglottic obstruction with granulation tissue. Although these patients were effectively managed by local means, ineffective management of intratracheal granulation tissue may convert a minor, temporary problem into a serious chronic obstruction. Cricothyroidotomy is appropriately used for prolonged airway access only in patients free of acute laryngeal pathology.
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Cricothyroidotomies were performed upon 147 patients at the New York University Medical Center and Booth Memorial Center from March 1976 through February 1978. Cricothyroidotomy was demonstrated to be a rapid and technically simple and precise procedure. The incidence of complications was 8.6 per cent. ⋯ Cricothyroidotomy was performed following prolonged endotracheal intubation in these two patients who had airway obstruction immediately following endotracheal extubation. In both patients, there was a glottic and subglottic component to the laryngeal stenosis suggesting that endotracheal intubation as well cricothyroidotomy played a critical part in the development of laryngeal stenosis. In view of these observations, we believe that cricothyroidotomy is useful, particularly in emergency situations and in patients with median sternotomy incisions but is contraindicated in patients having endotracheal intubation of more than seven days' duration or in patients having airway obstruction develop following removal of an endotracheal tube except as a temporary lifesaving procedure.
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A simple, easily constructed cricothyrotomy cannula and its method of use are described. Experiments have demonstrated that the instrument admits adequate air to sustain life without causing trauma to the posterior laryngeal wall. The dimensions allow the concurrent use of the FG10 suction catheter. An accessory device which enables single instrument cricothyrotomy is also described.