Techniques for emergency tracheostomy.

Emergency standard open tracheostomy is performed in impending or actual cardiac and respiratory-cardiac arrest. Indications are rare, but the procedure must be safe and rapidly effective. Neither facilitating (but risky) neck manipulations nor electrocautery are required nor, because of the urgency to obtain airway ingress, are bilateral traction stitches applied. No intravenous line should be attempted, unless another operator is available or the patient is conscious and needs a rapid anaesthetic before a procedure. No anaesthetic is required in deep coma or cardiac arrest. In all other situations, etomidate, ketamine, remifentanyl or alfentanyl immediately, followed by ketamine or remifentanyl or sufentanyl or alfentanyl by continuous intravenous infusion, confer effective and safe emergency anaesthesia.