Tracheostomy
TRACHEOSTOMY ➢ A surgical procedure in which an opening is created in the anterior wall of the trachea. ➢ Tracheotomy / Tracheostomy temporary permanent ➢ Types: Temporary vs Permanent : Emergency vs Elective : High / mid / low
Indications: ➢ Upper airway obstruction : actual – FB, infection, absess, allergy,injury,tumour anticipated – any major operation above larynx
Indications: ➢ Upper airway obstruction : actual – FB, infection, absess, allergy,injury,tumour anticipated – any major operation above larynx ➢ Protection of tracheobronchial tree : coma (head injury, drug overdosage,CVA) Trauma (burns, facial fractures) Neurological diseases (polyneuritis, tetanus, myasthenia gravis,bulbar palsy) ➢ Ventilatory insufficiency : chest injury (flail chest) pulmonary diseases (COPD, asthma, pneumonia)
Beneficial effects of Tracheostomy ➢ Life saving measure ➢ 70% reduction in dead space ➢ Bypasses resistance to airflow ➢ Alows IPPV ➢ Bronchial toileting
Unwanted effects of Tracheostomy ➢ Loss of voice depression ➢ Lack of humidification ➢ Lack of filtration ➢ Lack of adequate cough reflex ➢ Diminished sense of smell, taste
Surgical procedure ➢ O.T. and sterile condition ➢ Anesthesia- LA / GA / nil ➢ Position- supine with neck extension Steps : ➢ incision-horizontal - midway between suprasternal notch & cricoid vertical - cricoid to suprasternal notch
Surgical procedure ➢ Dissection of soft tissue ➢ Separation of strap muscles - stay in the midline ➢ Lift up or divide the thyroid isthmus ➢ Divide pretracheal fascia ➢ Confirm the trachea by palpation & needle aspiration, inject 1 ml. of local anesthesia
Surgical procedure ➢ Tracheal incision - vertical -2nd and 3rd tracheal ring. In iadultresect a part of cartilage. In children- separate apart. ➢ Insert the tube. ➢ Inflation of the cuff and fixation of the tube. ➢ Closure of the wound ➢ Dressing
