Surgical airway

There are four ways to achieve oxygenation: bag-mask-ventilation, ventilation using an extraglottic device, a tracheal tube and a surgical airway. The creation of a surgical airway is often viewed as the last resort in a dire cannot intubate, cannot oxygenate airway emergency. It is also incorporated into the difficult airway algorithms of various specialist societies. Despite its importance, there are many issues regarding timing of and the expertise of practitioners in performing a surgical airway. The aim of this chapter is to enhance the reader's understanding of the anatomy of the cricothyroid membrane, the technique of performing a cricothyrotomy, and the importance of skill maintenance. The recent developments in ultrasound technology may help practitioners in identifying airway anatomy in patients with a predicted difficult airway. It should be emphasized that having to perform an open cricothyrotomy cannot be viewed as a personal failure to secure the airway by conventional methods. It is, after all, one of the four methods of ventilation and oxygenation.