The catheter is passed via an epidural needle through the cricothyroid membrane up into the oropharynx and the endotracheal tube is threaded over the catheter. Transtracheal ventilation methods. In this technique the neck is extended and a sharp instrument is used to puncture the cricothyroid membrane allowing a small diameter tube to be passed into the trachea. The tube is attached to high pressure source of oxygen to produce ventilation. If the tube is not in the trachea, there is a risk of surgical emphysema.
Commercial apparatus is available which permits the passage of a large tube.
If an anaesthetist is available who is experienced in the use of the fibreoptic equipment, this technique should be used. H2 blocker by I.V.I. 1 hr before attempt at intubation. Give small dose of I.V. induction agent. Ventilate lungs via a face mask. Where laryngoscopy impossible Local analgesia applied to the nose, pharynx and trachea will make possible blind intubation in the awake patient before anaesthesia is induced.