Background: Clinicians working in anesthesiology or critical care medicine often face
difficult airway situations. Moreover, time is limited to make the right decisions
while securing the airway for critically ill patients. Although the modern airway
management approach is strategy-based, it remains essential to provide an adequate
level of training to acquire technical skills. Cadaver-based skill training is considered
to be one of the highest levels of education. Aim: Using an innovative method we aimed
to create realistic artificial lesions making airway management difficult on specially
soft-fixed human preparations. Methods: We produced submucosal upper and lower airway
lesions by injecting green-coloured liquid silicone. First, 10 non-fixed human head
and neck visceral complexes were injected by suprahyoidal, infrahyoidal or transcricothyroidal
lateral punctures. After the silicone crosslinked, the preparations were fixed (4%
formaldehyde) and the lesions were visualized by sections. Then in situ lesions were
implanted by percutaneous puncture of 5 Thiel-fixed head preparations. Tracheal stenosis
was achieved by external ligature. Videolaryngoscopic images were taken under comparable
parameters before and after implantation. Results: The lesions created proved to be
realistic in their localisation and shape. The tissues were optimally infiltrated
and not fragile. In the in situ models significant airway stenoses and anatomical
deformities were induced. Conclusion: As first step of a long-term project the current
paper has only attempted to communicate modelling as a technical report on creating
standardized artificial airway difficulties for education or research. Our models
provide an opportunity to increase the anatomical diversity and realism of airway
management courses. A systematically designed educational unit consisting of several
cadavers is an invaluable tool in training, the role of which is planned to be analyzed.
(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
