Unrecognised drug error and subsequent airway management utilising ultrasound-guided cricothyroidotomy and Rapid-O2® oxygen insufflation

Abstract

Tubeless microlaryngoscopy optimises surgical access but typically relies on total intravenous anaesthesia, commonly using propofol and remifentanil infusions. We present a difficult airway case where an unrecognised drug error during programming of an infusion pump resulted in unexpected apnoea. Open airway surgery proceeded with the use of a prophylactic cannula cricothyroidotomy using a Rapid-O2® insufflation device to provide rescue oxygenation. Furthermore, cricothyroid membrane identification failed with digital palpation but was successful with ultrasonography. While the latter is currently not considered the standard of care for preparing for front-of-neck access in a time-critical ‘can’t intubate, can’t oxygenate’ scenario, in our case it proved helpful.