Viable oxygenation with cannula over needle cricothyrotomy

British Journal of Anaesthesia, 2011, Vol 7 Issue 4 : 642-643
Viable oxygenation with cannula-over-needle cricothyrotomy for asphyxial airway occlusion
W. A. Kofke*, J. Horak, M. Stiefel and J. Pascual

Philadelphia, USA

Editor—The appropriate initial surgical airway to use in a ‘cannot ventilate, cannot intubate’ (CICV) situation is not established and evidence from a controlled clinical trial or substantial case series is not likely to be forthcoming. Options include standard open surgical cricothyrotomy, cricothyrotomy, and cannula-over-needle cricothyrotomy with or without jet ventilation with 100% oxygen. We present a case of asphyxia (hypoxaemia/hypercapnia) after post-anaesthetic extubation with successful initial management with a 14 G cannula-over-needle cricothyrotomy and manually applied continuous positive airway pressure (CPAP) by 100% O2, all captured on an automated electronic anaesthesia record revealing dramatic resolution of hypoxaemia, despite total proximal airway occlusion.

A 69-yr-old Caucasian female, with a history of hypertension treated with an angiotensin-converting enzyme inhibitor, was undergoing elective angiogram and coiling of an unruptured cerebral aneurysm. A …


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