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Preemptive vessel dilator cricothyrotomy aids in the management of upper airway obstruction

[Une crico-thyrotomie préventive réalisée avec un dilatateur vasculaire aide la prise en charge de l’obstruction des voies aériennes supérieures]

James R. Boyce, MD^*, Glenn E. Peters, MD, William R. Carroll, MD, J. Scott Magnuson, MD, Allison McCrory, MD and Arthur M. Boudreaux, MD^*

^* From the Department of Anesthesiology, and
the Department of Surgery, University of Alabama at Birmingham Medical Center, Birmingham, Alabama, USA.

Address correspondence to: Dr. J.R. Boyce, UAB Medical Center, Department of Anesthesiology, 619 S. 19th St. Birmingham Al, 35249, USA. Phone: 205-934-7424; Fax: 205-975-1948; E-mail: jboyce{at}uab.edu

Purpose: Our objective was to demonstrate that preemptive vessel dilator cricothyrotomy may be useful when managing the patient with airway obstruction.

Methods: An Institutional Review Board approved retrospective study was undertaken in 88 patients for whom this technique was selected. The anesthesiologists and surgeons identified as authors were directly involved in the care of these patients. All vessel dilator cricothyrotomies were performed in the operating rooms of University Hospital, UAB, Medical Center. The patients selected for this airway management technique were afflicted with some type of supraglottic lesion, usually squamous cell carcinoma, which was obstructing their airways to an extent that complete airway obstruction during induction of anesthesia was a significant possibility.

Prior to induction of anesthesia, the vessel dilator was inserted into the tracheal lumen through the cricothyroid membrane as described. Oxygenation was maintained with jet ventilation from a Sanders jetting device. Age, sex, weight, initial and lowest O₂ saturation, first recorded ETCO₂, blood pressure and duration of jet ventilation were recorded.

Results: The airways were successfully managed in all 88 patients with this technique. There were no deaths, and no postoperative hypoxic sequelae; also complications were minor.

Conclusion: Vessel dilator cricothyrotomy as a preemptive procedure in the management of patients with significant supraglottic airway obstruction may be a useful addition to the anesthesiologists’ armamentarium of airway management devices.