In reality,
an anesthesiologist cannot maintain competency with the esoteric (retrograde wire) or open trachs, and a failed airway aint the place for you to try something you've done twice.
In your life.
We have a backstage pass, though, to managing the failed airway via being comfortable with the transtracheal block thats commonly done for fiberoptics.
I'd say being able to perform the transtracheal block is a skill that'll enable you to handle a failed airway.
Most of us have done enough of them to be able to find, and cannulate the cricothyroid membrane fairly quickly.
It is my humble opinion that as an anesthesiologist, you should have one skill in the failed airway area that you're really good at, and I'd be willing to bet that cannulating the cricothyroid membrane is where the moneys at for most of us.
Can you find the membrane and stick it with something (21" needle/20"angiocath) in order to squirt in some lidocaine for a fiberoptic under controlled circumstances?
Sure you can.....and the cool thing is you can practice periodically.
So exploit that skill of yours, and make it your GO-TO step when everything else fails.
Refine it.
Start feeling cricothyroid membranes for a while again.
Pretend the ASA 1 knee scope you just threw an LMA #4 in just lost their airway.
Time yourself on how long it takes you to find the membrane.
Its gravy after you find it.
Take out the jet ventilator setup. Knock the cobwebs off of it. Hook it into the 02 thinghy.
Take out a 14" angio and hook up the setup to the catheter. Squirt it a cuppla times.
Now take it apart, and pretend youre gonna stick this ASA 1's cric with everything set up.....during the case.
You can do it.
I've done it twice in eleven years.
This is where the moneys at for most practicing anesthesiologists managing a failed airway.
JET VENTILATION.