Invasive Airway Access Techniques for Anesthesiologists

Abstract

  Invasive airway access is a fundamental technique that anesthesiologists must acquire in preparation for “cannot ventilate-cannot intubate” situations. Cricothyrotomy, which can be performed surgically or percutaneously, is suitable in an emergency because it is quick and safe and can be performed reliably compared to tracheostomy. There are a variety of commercially available kits for cricothyrotomy, which vary in the sizes of the cannula and insertion procedures, such as the Seldinger and catheter-over-needle methods. Therefore, anesthesiologists must know the strengths and weaknesses of each kit to determine which one is appropriate for each case. The choice of method for cricothyrotomy, which includes surgical incision, depends on the individual circumstances, i.e., the degree of urgency of the situation, desired ventilation volume, skill of the operator, condition of the insertion site in the neck, and the availability of the kit. Needle cricothyrotomy requiring a high-pressure oxygen source (transtracheal jet ventilation) is not a definite measure for securing the airway because it might cause barotrauma and circulatory collapse, unless the upper airway is kept patent to release expired gas. Therefore, it is necessary to select a kit with a cannula with an internal diameter of more than 4 mm to ensure successful ventilation.