Use of the Trousseau dilator in cricothyrotomy

When performing cricothyrotomy, once the initial incision has been created, the scalpel handle may be inserted into the incision and rotated, or a Tro usseau dilator may be used to widen the opening. During endotracheal (ET) t ube passage, the Trousseau dilator may be left in place or a tracheal hook may be inserted for tracheal stabilization. This experimental crossover tri al of cricothyrotomy in a cadaver model compared: 1) scalpel handle rotatio n to the use of a Trousseau dilator in widening the initial incision, and 2 ) the use of a tracheal hook to a Trousseau dilator during ET tube passage. Part 1: Cricothyrotomy incisions were made in 30 formalin-fixed cadavers u sing a #11 scalpel blade. The opening was initially widened using a Trousse au dilator or a scalpel handle rotated through 360 degrees, Progressively l arger ET tubes were passed using a tracheal hook for stabilization at the t hyroid cartilage, and the size of the largest ET tube passed without signif icant resistance was recorded, Each opening was then widened using the othe r technique and ET tubes again passed as above, The dimensions of the openi ng after initial dilatation and after final ET tube passage were also recor ded. Part 2: A tracheal hook inserted cephalad at the thyroid cartilage or a Trousseau dilator was used to stabilize the trachea during passage of pro gressively larger ET tubes, and the size of the largest ET tube passed with out significant resistance was recorded. The insertion techniques were then reversed and ET tubes again passed as above, The trachea was inspected for damage and the balloon cuff checked for rupture after each attempt. Descri ptive statistics were applied using a paired t-test and a chi-square analys is. We found no significant difference between the two techniques with rega rd to initial opening dimensions, final opening dimensions, or maximal ET t ube size. There was no damage to local tissue and no balloon cuff ruptures. We found that the average size of the largest ET tube passed was significa ntly greater with the use of a tracheal hook (internal diameter mean 7.0 mm , median 7.0 mm) than with a Trousseau dilator (internal diameter mean 5.7 mm, median 5.5 mm), There was no damage to local tissue and no cuff rupture s. We conclude that the scalpel handle rotation technique is equal to the u se of the Trousseau dilator with regard to opening size and maximal ET tube size but that use of a tracheal hook rather than a Trousseau dilator allow s for passage of a larger ET tube in a cadaver model of cricothyrotomy. (C) 1999 Elsevier Science Inc.