• be careful of perforating trachea / carina with bougie
• be careful of endobronchial intubation
• primary = cricothyroid membrane
• beware BV with cricotracheal / tracheal interspaces

• CICO

• scalpel blade = number 10
• ETT 6.0 mm cuffed
• bougie

• stand on the side of the patient of your non-dominant hand
• Right-handed operator
  • stand on patient's left hand side
  • operator's left hand is caudal and stabilises larynx

• stabilise thyroid cartilage with non-dominant hand
• 4 cm vertical incision with dominant hand
  • over cricothyroid membrane
  • may need to extend from mandible to sternum
• horizontal (transverse) incision through CTM
• Dilate with finger
• Pass bougie alongside finger
• pass ETT over bougie

• transverse stab through CTM
• rotate 90°
• slide bougie alongside scalpel into trachea
• pass ETT over bougie

• vertical 8-10 cm incision
• blunt dissection with fingers to larynx
  • Dissection is the important difference
• proceed with
  • Cannula technique (Heard)
  • Scalpel technique

• similar to needle cricothyroidotomy
• use syringe with 5mL water when aspirating

BJAE 2019