Tracheostomy

Definition : An opening made in the trachea is called tracheostomy.

Indication:

• Emergency: choking, stridor
• Elective: Coma , tetanus, barbiturate,head injuries, pulmonary insufficiency

Contraindications:

• Anaplastic carcinomathyroid patients presenting with stridor due to infiltration of growth into trachea. 

Anaesthesia: LA

Procedure:

• Incision: Tranverse curved incision 3-4cm at the level of 2nd tracheal ring. 
• Dissection: Skin , subcutaneous tissue and deep fascia are incised.Isthmus of thyroid is separated.
• Procedure: A transversed curved cut is made at the level of 2nd tracheal ring, its edge is held by Allis forceps and a small cuff of cartilage is removed. Cricoid hook can be used to stabilise the trachea (found more usefull in children).
• A suitable sized tracheostomy is introduced within.
• The cuff of tracheostomy tube is inflated by using 2-5ml of air and is held in place by passing a tape around the neck.
• Confirm the tube in the trachea not in the subcutaneous plane.
• Confirm air entry into both lungs.

Post op Rx

• Suction of tracheostomy tube
• Regular dressing
• Humidification of air
• Check for air entry

Post op complication

• wound infection
• Air leakage
• Improper air entry
• cricoid stenosis