Cricothyroidotomy, percutaneous cricothyroidotomy, cricothyroidotomy, it is a method of opening the airways with the use of incision of the cricothyroid ligament. Used in emergencies, it allows you to open the airways and save the patient's life. What are the contraindications for this treatment? Can there be complications after cricothyroidism?

Contents:

  1. Conicotomy - indications
  2. Conicotomy - contraindications
  3. Conicotomy - complications
  4. Konikotomy - preparation
  5. Surgical cricothyrotomy - procedure
  6. Surgical cricothyotomy and tracheotomy
  7. Surgical cricothyrotomy versus conicotomy (needle cricothyrotomy)

Cricothyrotomy(Latin conicotomy) or otherwisecricothyroid glandularis an invasive method of clearing the airways. It is most often used in accident victims and people in whom less radical methods fail, and the airway obstruction occurred at or above the glottis.

Conicotomy - indications

Cricothyrotomy is performed when it is impossible to open the airway by other methods, including intubation of the patient endotracheally. The main indications for cricothyroidism are:

  • sudden obstruction at or above the level of the larynx
  • no intubation possible due to glottic spasm
  • craniofacial defects: Pierre Robin syndrome, Treacher Collins syndrome
  • cervical spine defects: Down syndrome, Klippel-Feil syndrome, Goldenhar syndrome, torticollis
  • foreign body in the respiratory tract that cannot be removed, e.g. a piece of food
  • maxillofacial trauma
  • anaphylactic shock resulting in swelling

Conicotomy - contraindications

The most important contraindication to cricothyrotomy is the possibility of endotracheal intubation. This procedure is less invasive for the patient. A plastic tube is used that is inserted through the mouth to open the airway with a laryngoscope.

Another contraindication is not finding the cricothyroid ligament, which should be cut during the cricotomy. Before the continuity of the tissues is broken, the person performing the cricothyrotomy must be sure that they are cutting the ligament.

Conicotomy -complications

  • haemorrhage - caused by a vessel puncture
  • pneumothorax: subcutaneous pneumothorax, pneumothorax, pneumothorax, pneumothorax
  • damage to the esophagus wall
  • infection

Konikotomy - preparation

The patient should lie on his back with his head tilted forward to make access to the neck structures as easy as possible. Place a roller or a pillow under your shoulders, the head and neck must be in the middle of the body. The equipment necessary to perform a cricothyroidectomy is:

  • intravenous cannula
  • syringe
  • endotracheal tube connector
  • self-inflating bag to mechanically support ventilation

In the case of a surgical cricothyroidism, a scalpel, a penny, and a cricothyroid tube are also necessary.

Surgical cricothyrotomy - procedure

After the patient is properly positioned, the assistant gives oxygen through an oxygen mustache or an oxygen mask. The person performing the procedure is positioned on the left side of the patient if the patient is right-handed, and the other way around in the case of left-handed people. If you can feel the thyroid ring:

  • the operator stabilizes the larynx and makes a transverse incision
  • inserts the guide to a depth of about 10 cm, then a gel-coated tube
  • fill the tube cuff and ventilate during intubation

If you cannot feel the thyroid ring:

  • if available, ultrasound assesses vessels and the midline of the neck
  • tightens the skin of the neck with his left hand and makes an incision into the skin
  • dissects, stabilizes the larynx, locates the ligament

Surgical cricothyotomy and tracheotomy

Tracheotomy, just like cricothyroidism, serves to open the airways. The difference is where the tube is inserted - in the case of a tracheotomy, it is the windpipe.

Surgical cricothyrotomy versus conicotomy (needle cricothyrotomy)

During conicopuncture, locate the cricothyroid ligament in the incision made. Then the cricothyroid ligament is punctured with a needle. The puncture is made at a slight angle towards the caudal.

Then aspirate air to confirm placement of the cannula in the lumen of the trachea.

Incision with a scalpel (cricothyroidism) is currently preferred as this allows lower pressure ventilation, which reduces the risk of barotrauma.

Additionally, the cannulas used during concomitant function may turn out to be ineffective in patients with thoracic injuries and may bend.

About the authorNatalia MłyńskaStudent of medicine atMedical University of Lodz. Medicine is her greatest passion. He also loves sports, mainly running and dancing. She would like to treat her future patients in such a way as to see them as a human being, not only a disease.

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