Anesthesiologists maintain patient oxygenation during surgery, typically through endotracheal intubation. However, intubation is not always an option for some patients, such as those undergoing surgery in or around the upper airway, and intubation can fail — necessitating surgical airway proficiency.
Two primary surgical airway types exist: cricothyrotomy and tracheostomy. Cricothyrotomy involves making an incision through the cricothyroid membrane, located near the Adam's apple, and inserting a tube to provide oxygen. Needle cricothyrotomy represents an alternative approach that uses a large-bore needle rather than a formal incision.
The technique gained mainstream adoption in the 1970s following Brantigan and Grow's published research. Cricothyrotomy is employed when other methods of intubation have failed and there is a pressing need for an airway, such as in "Cannot Intubate, Cannot Oxygenate" (CICO) scenarios. Benefits include accessibility and speed of execution. Risks encompass laceration of the tracheal cartilage, perforation of the trachea, and infection, as well as long-term complications such as voice changes.
Tracheostomy is a more complex and deliberate procedure that addresses long-term ventilation needs, including inability to extubate, maxillofacial trauma, laryngeal or neck trauma, and obstructive sleep apnea among other indications. It involves making an incision just below the cricoid cartilage and inserting a tracheostomy tube.
Advantages of tracheostomy include improved patient comfort for long-term airway management. Risks include hemorrhaging, infection, tube dislodging, and pressure necrosis at the tracheostomy site.