Surgical Airway

[W222]

Is this ever within the scope of practice for an anesthesiologist? Can anyone think of a situation where it may be within the scope? Has anyone here actually done one?

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[UTSouthwestern]

Is this ever within the scope of practice for an anesthesiologist? Can anyone think of a situation where it may be within the scope? Has anyone here actually done one?

Ideally no, but it is within the scope of practice in an emergency situation, usually in the form of an emergency cric.

Yes I have done several and while I am glad I have the experience, I would love to never have to be in those situations every again.

 

[W222]

Ideally no, but it is within the scope of practice in an emergency situation, usually in the form of an emergency cric.

Yes I have done several and while I am glad I have the experience, I would love to never have to be in those situations every again.

Thanks. I was at an interview recently and an attending was talking about how a bad situation presented itself and it really would have been ideal for a surgical airway but no surgeons were ready and the anesthesiology resident wasn't trained in it yet.

 

[numbmd]

I have had to do it twice. Each time it was a choice of cutting the neck or death. Never fun.

 

[jwk]

I've seen it done twice, both times with patients with huge neck hematomas. I have never, in 28 years, seen it done for a surprise "unable to intubate / unable to ventilate" scenario. I'm sure it happens, but it happens far more often in the ED or in the field with those who are much less adept at laryngoscopy.

 

[gasnewby]

were you guys trained in residency for that? cool. did you do it open or needle?

 

[jwk]

were you guys trained in residency for that? cool. did you do it open or needle?

Cool would not be the appropriate adjective - it's major pucker time.

Every anesthesia provider should know how to do a cricothyrotomy - we practice it every single year as part of a difficult airway proficiency review that is required for all members of the department - MD, AA, and CRNA. That same review includes retrograde wires, light wands, bougies, combitubes, glidescope, bullard, and every variation of LMA that we carry.

 

[Tenesma]

there are some hospitals where the anesthesia team does all the trachs on the floors - usually with an attending and 2 residents (or ICU fellow and resident... now these are percutaneous trachs in patients who are already intubated....

emergency crics are a mess - and most people train to do them...

the reality is that most patients who need emergency crics are not the easy necks where you can feel ANY landmarks - they are usually either OBESE with NO neck OR they have facial trauma beyond recognition with blood pouring all over the place