Tracheostomy
Objective
The establishment of an opening into
the trachea below the larynx for the insertion of a tube for the purpose of
providing an airway in cases of upper respiratory
obstruction.
Position
Supine, with a sand bag under the shoulder, blades, neck
extended, with the head thrown well back and the chin in the midline.
Anesthesia
• In cases of emergency,
local field block or no anesthesia
• In
elective cases, general anesthesia.
Procedure
1. The trachea is fixed between the thumb and middle finger in the
midline and an incision is given dividing the skin and platysma.
2. In cases of urgency a vertical incision, running
from just an inch above the cricoid cartilage to the suprasternal notch.
3. In elective cases a transverse incision is
given along the skin creases, midway between the cricoid cartilage and the
suprasternal notch.
4. The strap muscles are retracted laterally to
expose the trachea with the overlying isthmus of thyroid.
5. The isthmus is freed by dividing the
pretracheal fascia in front of cricoid cartilage.
6. The freed isthmus can be divided pulled down
with the blunt tracheal hook to expose the tracheal rings.
7. Now inject a few drops of topical anesthetic
into the trachea to minimize the bout of coughing on sudden opening of the
trachea.
8. The trachea is fixed by means of a sharp hook
and second and third tracheal rings are divided in midline.
9. The opening so formed is dilated using
tracheal dilator.
10. A correct size tube is selected and introduced
into the opening.
Instruments
Tracheostomy set.
Any questions be sent to drmmkapur@gmail.com
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