Although instances when management of an airway has progressed down the algorithm to the need for an emergency surgical airway are fortunately rare, it is sometimes necessary to perform this procedure to gain control of the airway. In the past, there was most likely “a surgeon within earshot,” but with the advent of more restricted residency work hours and the need to do more cases to generate the same billing income, surgeons are “spread more thinly” than in the past.

A cricothyroidotomy is a variant approach to tracheostomy and is considered by surgeons to be the preferred technique for initial emergent surgical airway management. The cricothyroid membrane is generally easy to locate and is fairly avascular. Because cricoid cartilage chondritis with the unfortunate sequelae of subglottic stenosis can develop after cricothyroidotomy, revision to a conventional tracheostomy, usually at the second or third tracheal ring (which involves exposing and separating the strap muscles and dividing the thyroid isthmus) is generally performed within 24 hours.

The most important step in performing a cricothyroidotomy successfully is making the decision to do one. The second most important step is remaining calm; it is the authors’ opinion that most anesthesiologists have the technical skills necessary to facilitate an “emergency surgical airway” via cricothyroidotomy.

The steps used by general surgeons in performing emergent cricothyroidotomy are as follows.