From the Guidelines
Gooseneck intubation is not the recommended technique for managing difficult airways, as the most recent and highest quality evidence suggests alternative methods, such as the use of a cannula through the cricothyroid membrane, as outlined in the Difficult Airway Society guidelines 1. When managing difficult airways, it is crucial to prioritize techniques that minimize complications and ensure effective ventilation. The guidelines provide a step-by-step approach for managing unanticipated difficult intubations, including:
- Inserting a cannula through the cricothyroid membrane
- Maintaining the position of the cannula with an assistant's hand
- Confirming tracheal position by air aspiration using a 20ml syringe
- Attaching a ventilation system to the cannula
- Commencing cautious ventilation
- Confirming ventilation of the lungs and exhalation through the upper airway If ventilation fails or complications develop, the guidelines recommend converting immediately to surgical cricothyroidotomy 1. Key considerations when managing difficult airways include:
- Ensuring adequate ventilation and oxygenation
- Minimizing the risk of complications, such as surgical emphysema
- Being prepared to convert to alternative techniques, such as surgical cricothyroidotomy, if necessary In real-life clinical practice, it is essential to prioritize techniques that have been shown to be effective and safe, as outlined in the most recent and highest quality evidence 1.
From the Research
Gooseneck Intubations
- There is no direct evidence in the provided studies regarding gooseneck intubations.
- However, the studies discuss various aspects of intubation, including awake fiberoptic intubation 2, 3, rocuronium dosing for rapid sequence intubation 4, 5, and emergency airway management in difficult airways 6.
- Awake fiberoptic intubation is a recommended strategy for managing anticipated difficult airways, with a high degree of efficacy and safety observed in the studies 2, 3.
- The use of rocuronium for rapid sequence intubation has been studied, with optimal dosing ranges identified for first-attempt success 4, 5.
- Difficult airways are a significant challenge in emergency settings, with a need for innovative solutions to improve first-pass success rates and reduce adverse events 6.