Letter to the Editor  |   February 2014
Ditch the Needle – Teach the Knife
Author Affiliations
  • C. Phillip Larson, Jr., M.D.
    Professor Emeritus, Anesthesia and Neurosurgery Stanford University Professor of Clinical Anesthesia David Geffen School of Medicine, UCLA
Article Information
Letter to the Editor
Letter to the Editor   |   February 2014
Ditch the Needle – Teach the Knife
ASA Monitor 02 2014, Vol.78, 63.
ASA Monitor 02 2014, Vol.78, 63.
I read with interest the case report number 2013-10 in the October NEWSLETTER by Dr. Dutton, regarding use of a knife or needle in emergency airway management. The only reason there is any debate about this matter is that most anesthesia personal have no real-life experience with either technique, and hence have no way to judge which is better. However, in a life-threatening airway obstruction, there is no question which is better. An emergency cricothyrotomy is much quicker, easier, safer and more effective than any needle-based technique. I can state with confidence that there is no place in emergency airway management for needle-based attempts to establish ventilation. It should be deleted from the ASA Difficult Airway Algorithm. I have participated in seven cricothyrotomies in emergency airway situations, and all of the patients left the hospital without any neurological injury or complications from the cricothyrotomy. The risk-benefit ratio is markedly in favor of the knife technique.
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