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Front of Neck Access
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Needle techniquePalpate the neck structures in the midline and identify the thyroid cartilage, cricoid cartilage and cricothyroid membrane in between the two cartilages.Using a small calibre angiocath and saline-containing syringe, the cricothyroid membrane is punctured at a 45 degree angle in the caudad direction, the airway is confirmed (using aspiration) and the angiocath is inserted percutaneously.High-pressure oxygen is insufflated into the trachea. The expiration is passive. This technique is known as jet ventilation.
Airway Surgery
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
Intermittent jet ventilation using a hand-held injector will entrain room air via the Venturi principle and can be used with either a catheter through the cords or attached to the side of a ventilating rigid bronchoscope. Transtracheal jet ventilation, either with a hand held injector or a high frequency jet ventilator, may be used via a cricothyroid cannula to maintain oxygenation where the anatomy of the larynx is severely abnormal. With jet ventilation a clear expiratory pathway must be present to avoid barotrauma. Apnoeic oxygenation and methods of jet ventilation require incremental doses or infusions of intravenous anaesthetic agents to prevent awareness.
Equipment
Published in Sarah Armstrong, Barry Clifton, Lionel Davis, Primary FRCA in a Box, 2019
Sarah Armstrong, Barry Clifton, Lionel Davis
Jet ventilation; for example jetting with entrained air down a rigid bronchoscope or using a Carden's tube for microlaryngeal surgery. This is attached to a 400 kPa wall outlet. High frequency jet ventilators are available for longer-term use, for example in ITU for lung protection ventilation strategies
Prehospital Surgical Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Robert F. Reardon, Aaron E. Robinson, Rebecca Kornas, Jeffrey D. Ho, Brendan Anzalone, Jestin Carlson, Michael Levy, Brian Driver
When performing surgical airways, EMS clinicians experience higher success with the use of open scalpel techniques (11). Also, most emergency physicians prefer an open scalpel technique when performing an emergency surgical airway. A systematic review of transtracheal jet ventilation concluded that it was associated with a high risk of device failure and barotrauma and recommended against using it in the emergency setting (49). In addition, there has been debate in the anesthesiology literature about the relative merits of needle cannula (Seldinger: needle-guidewire-cannula) techniques (50). However, the 4th National Audit Project of major airway complications in the United Kingdom evaluated 79 failed airways in the hospital setting that required a surgical airway. They found a 2% failure rate for open surgical airway techniques compared with a 65% failure rate for needle cannula techniques (51). These findings led to the Difficult Airway Society’s strong recommendation for the use of scalpel cricothyrotomy techniques (46). In addition, data from the National Emergency Airway Registry shows that in U.S. emergency departments open scalpel techniques have now completely supplanted needle cannula techniques (52).
Anesthetic consideration for airway management in patient undergoing tracheal resection and reconstruction for severe postintubation tracheal stenosis: a case report
Published in Postgraduate Medicine, 2021
Yi Chen, Hong Liao, Yuanyuan Niu, Xinli Ni, Jianzhen Wang
Development of an optimized ventilation strategy was crucial to ensuring a successful surgical outcome and maximizing patient safety. Because the tracheal lumen was constricted more than 80%, an adequate ventilation mode and airway management were needed to avoid hypoxemia with hypercapnia during the first phase of the surgical procedure prior to incision of the main trachea. Local anesthesia would have required thoughtful cooperation and communication from the patient, as bucking, tracheal spasm, and endotracheal hemorrhage can occur and become life-threatening. Tracheotomy and awake fiberoptic intubation were unlikely to be performed. Although the tracheal stenosis was located 3–4 cm from the glottis, no available intubation space was present for the endotracheal tube cuff past the glottis; thus, the probability of glottis injury with intubation and cuff inflation was deemed high. Jet ventilation and apneic oxygenation method (allow surgical intervention more than 3 minutes) were also efficacious options for ventilation [13]. Jet ventilation has the additional advantages of improving surgical visualization and minimizing peak airway pressure and its negative effects on cardiac output during TRR. However, it is associated with imperfect ventilation, hypercarbia, barotrauma, tension pneumothorax, and subcutaneous emphysema [10].
Stents for small airways: current practice
Published in Expert Review of Respiratory Medicine, 2020
Paul Zarogoulidis, Konstantinos Sapalidis, Christoforos Kosmidis, Kosmas Tsakiridis, Haidong Huang, Chong Bai, Wolfgang Hohenforst-Schmidt, Stavros Tryfon, Anastasios Vagionas, Konstantinos Drevelegas, Eleni-Isidora Perdikouri, Lutz Freitag
Interventional bronchoscopy with balloon dilation can reestablish airway patency but restenosis can occur and it depends on the plasticity of the inflammatory tissue. This technique is usually used in benign stenosis where we have scar tissue. Regarding malignancies, restenosis depends on the effectiveness of the systematic and local treatment before stent placement. Depending on the cancer type (lung cancer or metastatic cancer), patients receive systematic therapy and in some cases local therapy with radiotherapy and ablation with microwaves or argon plasma coagulation, YAG-laser, and/or cryotherapy probe. Usually we treat the patient under general anesthesia, we insert a rigid bronchoscope with a diameter depending from the trachea of the patient. Sometimes we can just intubate the patient with a large diameter tube No. 9 and insert flexible instruments from there (semi-rigid technique). There is also the case where we can directly insert a stent with a laryngeal scope and special releasing equipment [3,4]. Jet-Ventilation model is usually used where available; with this mode of ventilation we keep high oxygen levels and low CO2 concentration during the procedure [5]. Extracorporeal oxygenation could also be used in some severe cases [6]. Fluoroscopy and or cone beam CT can also be used in many patients for optimal stent insertion [3,7].