Prophylactic percutaneous transtracheal catheterisation in the management of patients with anticipated difficult airways: a case series*

Abstract

Summary Primary tracheostomy under local anaesthesia is indicated in the management of an anticipated difficult airway in patients in whom less invasive procedures are expected to fail or have already failed. However, primary tracheostomy is a relatively complex procedure and places not inconsiderable stress on the patient. In a prospective study in our hospital over a period of 22 months, we were able to avoid primary tracheostomy in 11 patients with very difficult airways. All 11 patients were managed with prophylactically inserted transtracheal catheters and jet ventilation of the lungs. This ensured an adequate oxygen supply during tracheal intubation, and made overall patient management much easier. This method has established itself as a standard procedure in our hospital.

Progress in management of the obstructed airway

“…The use of narrow bore cannula as an elective technique inserted awake either through the cricothyroid membrane or upper trachea has been described [37][38][39] and in experienced hands allows ventilation throughout surgery in patients with significant airway obstruction and stridor [9]. If there are concerns about the calibre of the patient's airway at the end of surgery, the narrow bore cannula can be left in place, or a definitive surgical tracheostomy performed.…”

Prophylactic percutaneous transtracheal catheterisation

“…Gerig et al outline their experience of prophylactic percutaneous transtracheal catheterisation in the management of patients with anticipated difficult airways [1]. We wholeheartedly agree that usually this is a straightforward and elegant method of avoiding life-threatening hypoxia in patients with anticipated difficult airways.…”

“…The study in the reference that is quoted to demonstrate the benefits of low volume resuscitation [1] took place in rats that had undergone puncture to the aorta. It showed improved survival in those animals resuscitated with fluids except those where attempts were made to achieve a 'normal' blood pressure.…”

Airway management in angiotensin converting enzyme inhibitor related angioedema

“…Pre-emptive, precautionary cricothyroidotomy has been shown to be an effective "insurance policy" in a variety of airway pathologies. 4 This allows immediate oxygenation and ventilation if the airway becomes further compromised, and provides an effective bridge to definitive management. If the patient can be oxygenated via a cannula cricothyroidotomy, then the airway can be secured by either an awake fibreoptic technique, direct laryngoscopy under general anesthesia, or by tracheostomy depending on the operator's expertise.…”