Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Tracheotomy PowerPoint PPT presentation
TRACHEOSTOMY
TECHNIQUE
Whenever possible, endotracheal intubation
should be done before tracheostomy.
Position: Supine with pillow under shoulders so
that neck is extended. This brings the trachea
forward.
Anaesthesia: Not required if pt unconscious or
emergency. In conscious pts, 1-2% lignocaine with
epinephrine is infiltrated in the line of incision and
area of dissection.
Sometimes gen anaesthesia.
STEPS OF OPERATION
1.Vertical midline incision in the neck extending from
cricoid cartilage to just above sternal notch (rapid
access, minimum bleeding & tissue dissection)
Transverse incision 5cm long two fingerwidth
above sternal notch gives cosmetical y better scar.
2. Tissues are dissected in the midline. Dilated veins
are either displaced or ligated.
3. Strap muscles are seperated in midline and
retracted lateral y.
4. Thyroid isthmus is displaced upwards or divided
btw clamps and suture ligated'
5. A few drops of 4% lignocaine are injected in to
trachea to suppress cough.
6. Trachea is fixed with a hook and opened with a
vertical incision in the region of 3rd and 4th or 3rd
and 2nd rings. This is then converted in to a
circular opening.
7. Tracheostomy tube of appropriate size inserted
and secured by tapes.
8. Skin incision should not be sutured or packed
tightly.
9. Gauze dressing is placed btw skin and flange of
tube around stoma.
TRACHEOSTOMY IN INFANTS AND
CHILDREN
INDICATIONS
infants below 1 yr ? mostly congenital
Subglottic hemangioma
Subglottic stenosis
Laryngeal cyst
Glottic web
Bilateral vc paralysis
Children ? inflammatory and traumatic
Acute laryngotracheo bronchitis
Epiglottitis`
Diphtheria
Laryngeal edema
External laryngeal trauma
Prolonged intubation
Juvenile laryngeal papillomatosis
1.Preferably done under gen anesthesia
With a endotracheal tube or bronchoscope
inserted.
Trachea of infants and children is soft and
compressible.
2. Do not extend neck too much
3. Before incision silk sutures are placed in the
trachea on either side of midline
4. Small lumen ? do not insert knife too deep
5.Trachea is simply incised , without excising a
circular piece of tracheal tube
6. Avoid infolding of ant tracheal wall when
inserting the tube
7. Selection of tube important
8. Use soft silastic or portex tube.
Metallic tube cause more trauma.
9. Take a postoperative x-ray of neck and chest to
ascertain the position of tracheostomy tube.
Thankyou
This post was last modified on 12 August 2021