From the Guidelines
The advantage of vertical incision over transverse incision in surgical cricothyroidotomy is that it causes less hemorrhage (option c). According to the guidelines for the management of tracheal intubation in critically ill adults 1, a vertical incision is recommended when the cricothyroid membrane is impalpable. This approach allows for better hemostasis and minimizes the risk of vascular injury. The use of a vertical incision also enables the surgeon to extend the incision if needed without increasing the risk of bleeding, which is crucial in emergency situations where rapid airway access is essential for patient survival. Some key points to consider when performing a surgical cricothyroidotomy include:
- Using a scalpel with a wide blade (e.g. number 10 or 20) for the incision 1
- Inserting a bougie as a guide for the tracheal tube 1
- Using a cuffed tracheal tube (5.0-6.0mm ID) to provide a definitive airway and enable the application of PEEP 1 Overall, the vertical incision approach is preferred in situations where the cricothyroid membrane is impalpable, as it provides better hemostasis and minimizes the risk of complications.
From the Research
Advantages of Vertical Incision
The advantages of vertical incision over transverse incision in surgical cricothyroidotomy are not explicitly stated in the provided studies. However, some studies provide information on the procedure and its complications:
- The studies do not directly compare the advantages of vertical incision over transverse incision in surgical cricothyroidotomy 2, 3, 4, 5, 6.
- One study discusses the anatomy of the cricothyroid space, which may be relevant to understanding the procedure, but does not address the specific question of incision type 6.
- Another study compares needle vs surgical cricothyroidotomy, but does not discuss the advantages of vertical incision over transverse incision 4.
Complications and Considerations
Some studies discuss the complications and considerations associated with cricothyroidotomy:
- The overall complication rate for cricothyroidotomy was 6.1% in one study, with one cricothyroidotomy-associated death 2.
- Acute complications, such as bleeding and misplacement of the airway, were rare in another study 3.
- Long-term complications, such as failure to decannulate and vocal cord paralysis, were also reported 3.
Incision Type
The provided studies do not specifically address the advantages of vertical incision over transverse incision in surgical cricothyroidotomy. Therefore, it is not possible to determine the correct answer based on the available evidence.