TRACHEOSTOMY
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TECHNIQUEWhenever possible, endotracheal intubation
should be done before tracheostomy.
Position: Supine with pillow under shoulders so
that neck is extended. This brings the trachea
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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.
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Sometimes gen anaesthesia.--- Content provided by FirstRanker.com ---
STEPS OF OPERATION1.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
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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.
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4. Thyroid isthmus is displaced upwards or divided
btw clamps and suture ligated'
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5. A few drops of 4% lignocaine are injected in totrachea 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
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circular opening.7. Tracheostomy tube of appropriate size inserted
and secured by tapes.
8. Skin incision should not be sutured or packed
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tightly.9. Gauze dressing is placed btw skin and flange of
tube around stoma.
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TRACHEOSTOMY IN INFANTS AND
CHILDREN
INDICATIONS
infants below 1 yr ? mostly congenital
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Subglottic hemangiomaSubglottic stenosis
Laryngeal cyst
Glottic web
Bilateral vc paralysis
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Children ? inflammatory and traumatic
Acute laryngotracheo bronchitis
Epiglottitis`
Diphtheria
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Laryngeal edemaExternal laryngeal trauma
Prolonged intubation
Juvenile laryngeal papillomatosis
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1.Preferably done under gen anesthesiaWith a endotracheal tube or bronchoscope
inserted.
Trachea of infants and children is soft and
compressible.
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2. Do not extend neck too much3. Before incision silk sutures are placed in the
trachea on either side of midline
4. Small lumen ? do not insert knife too deep
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5.Trachea is simply incised , without excising acircular piece of tracheal tube
6. Avoid infolding of ant tracheal wall when
inserting the tube
7. Selection of tube important
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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.
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Thankyou