Surgical airway management (bronchotomy) is the medical procedure ensuring an open

airway The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respiratory ...

between a patient’s

lung The lungs are the primary Organ (biology), organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the Vertebral column, backbone on either side of the heart. Their ...

s and the outside world. Surgical methods for airway management rely on making a surgical incision below the

glottis The glottis (: glottises or glottides) is the opening between the vocal folds (the rima glottidis). The glottis is crucial in producing sound from the vocal folds. Etymology From Ancient Greek ''γλωττίς'' (glōttís), derived from ''γ ...

in order to achieve direct access to the

lower respiratory tract The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respirator ...

, bypassing the

upper respiratory tract The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respiratory ...

. Surgical airway management is often performed as a last resort in cases where orotracheal and nasotracheal

intubation Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Most commonly, intubation refers to tracheal intubation, a procedure during which an endotracheal tube is inserted into the trachea to supp ...

are impossible or

contraindicated In medicine, a contraindication is a condition (a situation or factor) that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a rea ...

. Surgical airway management is also used when a person will need a

mechanical ventilator A ventilator is a type of breathing apparatus, a class of health technology, medical technology that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to ...

for a longer period. The surgical creation of a permanent opening in the

larynx The larynx (), commonly called the voice box, is an organ (anatomy), organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal ...

is referred to as laryngostomy. Surgical airway management is a primary consideration in

anaesthesia Anesthesia (American English) or anaesthesia (British English) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prev ...

emergency medicine Emergency medicine is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (or "ER doctors") specialize in providing care for unscheduled and undifferentiated pa ...

and

intensive care medicine Intensive care medicine, usually called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes p ...

. Surgical methods for airway management include

cricothyrotomy A cricothyrotomy (also called cricothyroidotomy or laryngotomy) is a medical procedure where an opening is created through the cricothyroid membrane to establish a patent airway during emergency airway management. Cricothyrotomy is primarily per ...

and

tracheostomy Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision on the front of the neck to open a direct airway to the trachea. The resulting stoma (hole) can serve independently as an airway ...

History

Asclepiades of Bithynia Asclepiades (; c. 129/124 BC – 40 BC), sometimes called Asclepiades of Bithynia or Asclepiades of Prusa, was a Greek physician born at Prusias-on-Sea in Bithynia in Anatolia and who flourished at Rome, where he practised and taught Greek medi ...

is credited with being the first person who proposed bronchotomy as a surgical procedure, though he never attempted to perform one.

Aretaeus of Cappadocia Aretaeus () is one of the most celebrated of the ancient Greek physicians. Little is known of his life. He was ethnically Greek, born in the Roman province of Cappadocia, Asia Minor (modern day Turkey), and most likely lived in the second half o ...

thought the procedure dangerous even as a remedy for

choking Choking, also known as foreign body airway obstruction (FBAO), is a phenomenon that occurs when breathing is impeded by a blockage inside of the respiratory tract. An obstruction that prevents oxygen from entering the lungs results in oxygen de ...

, since the resulting incision "''would not heal, as being

cartilaginous Cartilage is a resilient and smooth type of connective tissue. Semi-transparent and non-porous, it is usually covered by a tough and fibrous membrane called perichondrium. In tetrapods, it covers and protects the ends of long bones at the joints ...

''";

Caelius Aurelianus Caelius Aurelianus of Sicca in Numidia was a Greco-Roman physician and writer on medical topics. He is best known for his translation from Greek to Latin of a work by Soranus of Ephesus, ''On Acute and Chronic Diseases''. He probably flourished ...

also rejected its usefulness.

Cricothyrotomy

A cricothyrotomy is an incision made through the skin and

cricothyroid membrane The cricothyroid ligament (also known as the cricothyroid membrane or cricovocal membrane) is a ligament in the neck. It connects the cricoid cartilage to the thyroid cartilage. It prevents these cartilages from moving too far apart. It is cut ...

to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body,

angioedema Angioedema is an area of swelling (edema) of the lower layer of skin and tissue just under the skin or mucous membranes. The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs. Often it is associated with hives, which are ...

, or massive facial trauma. A cricothyrotomy is nearly always performed as a last resort in cases where orotracheal and nasotracheal intubation are impossible or contraindicated. Cricothyrotomy is easier and quicker to perform than tracheotomy, does not require manipulation of the cervical spine and is associated with fewer complications.

Needle cricothyrotomy

A needle cricothyrotomy is similar to a cricothyrotomy, but instead of making a scalpel incision, a large over-the-needle catheter is inserted (10- to 14-gauge). This is considerably simpler, particularly if using specially designed kits. This technique provides very limited airflow. The delivery of oxygen to the lungs through an over-the-needle catheter inserted through the skin into the trachea using a high pressure gas source is considered a form of conventional ventilation called percutaneous transtracheal ventilation (PTV).

Tracheotomy

A tracheotomy is a surgically created opening from the skin of the neck down to the trachea. A tracheotomy may be considered where a person will need to be on a mechanical ventilator for a longer period. The advantages of a tracheotomy include less risk of infection and damage to the trachea such as tracheal stenosis.

References

{{Respiratory system surgeries and other procedures Otorhinolaryngology

History

Cricothyrotomy

Needle cricothyrotomy

Tracheotomy

See also

References