Comparison of scalpel sizes for emergency airway access

Scalpel Showdown: Which Blade Makes the Cut for Emergency Airway Access?

Lena Voss in Health & Wellness June 2025 • 4 min read.

"A pilot study reveals surprising insights into the effectiveness and preference of different scalpel blades for front-of-neck airway procedures."

In emergency medicine, the ability to secure a patient's airway quickly and efficiently is paramount. When faced with a 'can't intubate, can't ventilate' scenario, a front-of-neck access (FONA) procedure, such as a cricothyroidotomy, becomes a life-saving intervention. The Difficult Airway Society recommends a size-10 scalpel blade in their Plan D guidelines, but anecdotal evidence suggests that other sizes, including size-22 blades, are also used.

Recognizing the critical nature of this procedure and the variability in practice, a pilot study was conducted to determine which scalpel blade types are most effective and preferred for emergency FONA techniques. The study aimed to provide data-driven insights that could refine training protocols and improve patient outcomes in these high-pressure situations.

This article delves into the methodology and findings of this pilot study, shedding light on the surprising preferences and performance metrics associated with different scalpel blade sizes. By examining the experiences of trainee anaesthetists, we uncover valuable lessons that could influence future guidelines and practices in emergency airway management.

The Scalpel Size Experiment: Training and Testing

Comparison of scalpel sizes for emergency airway access

The pilot study involved training two Core Trainee year-1 anaesthetists, both with no prior experience or training in FONA techniques. This ensured a level playing field and allowed for unbiased observation of their performance with different scalpel blades. The training protocol consisted of two key components:

First, the trainees watched a training video developed at the Royal Melbourne Hospital, providing them with a standardized visual guide to the FONA procedure. Second, they participated in a 15-minute practice session with an experienced instructor, using an animal larynx specimen to simulate a real-life scenario.

Kit 1: Size-11 blade
Kit 2: Size-22 blade
Kit 3: Size-10 blade

The candidates' attention was deliberately not drawn to the difference in the kits to avoid influencing their performance or preferences. The following parameters were recorded for each attempt: Time to insertion of the tracheal tube, accuracy of insertion, personal preference regarding equipment, and the length of the incisions on the external surface of the specimen.

Implications for Future Practice and Training

The pilot study's findings suggest that while all tested scalpel kits enabled correct tracheal tube placement, the size-22 scalpel was associated with the quickest placement time and was the preferred choice of the trainees. This may be attributed to the larger blade creating a longer skin incision, potentially facilitating easier insertion. However, these results are preliminary and warrant further investigation.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What is a front-of-neck access (FONA) procedure and why is it important?

A front-of-neck access (FONA) procedure, like a cricothyroidotomy, is a life-saving intervention performed when a patient's airway cannot be secured through traditional methods like intubation or ventilation. Guidelines often suggest using a size-10 scalpel blade for this procedure, but other sizes, such as size-22, are also utilized. Its importance lies in providing an alternative route for oxygen to reach the lungs in emergency situations, potentially preventing death or severe brain damage from lack of oxygen. Selecting the right blade may influence the time it takes to perform the procedure.

Can you describe the design of the pilot study that looked at scalpel blade sizes?

The pilot study compared the effectiveness of size-10, size-11, and size-22 scalpel blades in performing FONA procedures. Trainee anaesthetists, with no prior experience in FONA techniques, were trained and then tested using an animal larynx specimen. The time to tracheal tube insertion, accuracy, preference, and incision length were recorded. The goal was to determine if there were measurable differences in performance or preference among the different blade sizes, potentially leading to optimized training protocols.

What were the key findings of the pilot study regarding different scalpel blade sizes?

The study revealed that while all tested scalpel kits (size-10, size-11, and size-22) enabled correct tracheal tube placement, the size-22 scalpel was associated with the quickest placement time and was the preferred choice of the trainees. This outcome is significant because it challenges the convention of using a size-10 blade and suggests that a larger blade might offer advantages in terms of speed and ease of use. The quicker placement time with the size-22 blade may be attributed to the larger blade creating a longer skin incision, which could facilitate easier insertion of the tracheal tube.

What are the potential implications of the pilot study's findings for future practice and training in emergency airway management?

The study's finding, that the size-22 scalpel was preferred and resulted in quicker placement times, implies that current training protocols and guidelines might need to be re-evaluated. If further research confirms these results, training programs could incorporate the use of size-22 blades for FONA procedures. This shift in practice could potentially lead to faster and more successful airway interventions in emergency situations, improving patient outcomes.

Were there any limitations to the pilot study that should be considered when interpreting the results?

While the pilot study provides valuable insights, it is important to note that it involved a small sample size of only two trainee anaesthetists. Additionally, the study was conducted on animal specimens, which may not perfectly replicate the complexities of a human airway. Therefore, the results should be interpreted with caution, and further research with larger sample sizes and human subjects is needed to confirm these findings and establish definitive recommendations for scalpel blade selection in emergency airway access.