Surgical cricothyrotomy (SC) is an emergency airway procedure for assisting in ventilating patients who have insufficient oxygenation. It can be performed when other airway management options have been unsuccessful and the patient cannot be adequately oxygenated. The paediatric patient has differences in their airway anatomy compared to an adult patient. Any procedures on a paediatric patient are difficult and risky in any environment. This paper will discuss paediatric airway management and give reasons as to why SC should not be attempted.
SC involves incising the cricothyroid membrane with a scalpel and inserting an endotracheal tube directly into the subglottic area of the trachea. The most important anatomical consideration for a paediatric surgical airway is the smaller size of the cricothyroid membrane (CTM) in the paediatric patient compared to the adult patient; differences become less acute as the paediatric patient grows in size. Combining CTM size with the upper airway structures cartilage being soft and pliable as it develops; any pressure caused by surgical apparatus on the CTM may cause it to collapse completely (Caroline, 2007).
The paediatric patient has a shorter airway and the diameter is smaller. The narrowest area of the paediatric patient’s airway is situated below the level of the vocal cords at the cricoid cartilage and this differs from the adult patient’s airway as the narrowest point is located at the level of the vocal cords. Therefore the paediatric patient has a funnel shaped airway compared to the cylindrical shape of the adult patient’s airway (Caroline, 2007; Wheeler, Wong, & Shanley, 2009).
The anatomical features of the paediatric patient’s upper airway can make SC a difficult and dangerous procedure that can have negative results on the patient’s outcomes. Needle cricothyrotomy can be a more appropriate emergency option in