Coniotomy

Coniotomy and coniopuncture (also called cricothyrotomy) are procedures performed to urgently secure an airway in a situation where other measurements have failed or are not available. They are not intended for a long-term securing of the airway. They are rarely performed, however, potentially life-saving procedures.

The core of the procedure is to cut through (coniotomy) or puncture through (coniopuncture) the lig. cricothyroideum (lig. conicum) and following insertion of a tube to enable securing an airway. Coniotomy and coniopuncture are easy (the ligament is usually easily accessible) and quick to be performed, and require minimal technical requirements for the procedure and equipment.

The indication for impossibility to secure airways in another way is usually aspiration or stuck foreign object in the area of the vocal cord ligaments or in the subglottic area, extensive trauma in the orofacial area or different conditions causing difficult conditions for tracheal intubation or other alternatives (combitube, oropharyngeal airway, laryngeal mask) with impossible ventilation using a mask. It may also be a "cannot intubate, cannot ventilate" condition at the onset of general anaesthesia. In an emergency situation the procedure has no contraindication, the priority is to restore the airway as quickly as possible.

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