Anesthesia 5th year, 5th lecture (Dr. Gona)

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College of Medicine, Sulaymaniyah

The lecture has been given on Nov. 30th, 2010 by Dr. Gona.

Health & Medicine

Cricothyrotomy ,[object Object],[object Object]

Tracheostomy ,[object Object],[object Object],Uses for a tracheotomy The conditions in which a tracheotomy may be used are: Acute setting - maxillofacial injuries, large tumors of the head and neck, congenital tumors, e.g. branchial cyst , acute inflammation of head and neck, and Chronic / elective setting - when there is need for long term mechanical ventilation and tracheal toilet, e.g. comatose patients, surgery to the head and neck.

Uses for a tracheotomy ,[object Object],[object Object],[object Object]

Completed tracheotomy : 1 - Vocal cords 2 - Thyroid cartilage 3 - Cricoid cartilage 4 - Tracheal cartilages 5 - Balloon cuff

Complications: ,[object Object],[object Object]

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Surgical Management Of the Failed Airway: A guide to precutaneous cricothyrotomy Guidelines from Hoan E. Spiegel, MD Assistant Professor Beth Israel Ddeaconess Medical Center Harvard medical School Boston, MS Vipul Shah, MD Western Washington Medical Group Everett, Washington The first-known mention of an attempted surgical airway, a tracheostomy, was depicted on Egyptian tablets as early as 3600 BCE. History has condemned the emergent surgical airway when it has failed, but when successful, the physicians who performed it have risen in esteem to become "on a footing with the gods". Il 100 BCE, the Persian physician Asclepiades described in detail a tracheal incision for improving the airway. Yet most who advocated surgical approaches to the airway, including Asclepiades, were severely criticized. Vicq d'Azyr, a French surgeon and anatomist, first described cricothyrotomy in 1805. Emergent cricothyroidotomy /also known as cricothyrotomy, minitracheostomy, and high tracheostomy) became widely acknowledged and accepted in 1976 when Brantigan and Grow confirmed the relative safety of the procedure. A decade later, the Seldinger technique, a wire-over-needle procedure commonly used for intra-vascular cannulation, was adapted for use in obtaining both emergent and nonemergent surgical airways.

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Thoracotomy is the surgical procedure with an incision made to access the pleural space and the contents of the thoracic cavity. Given the structures to be accessed with in the cavity, different incisions have been established to easy the procedure and these incisions qualify the types of thoracotomies to be studied hereunder. PRE OP OPTIMIZATION FOR SPECIFIC FACTORS The outcome of surgical procedures is not measured only by clinical end points but also shorter stays and lower costs. Patients’ discharge is delayed commonly due to inadequate pain relief, infection, arrhythmias, prolonged air leak and debility. Many complications that occur from thoracic operations can be anticipated. An aggressive preoperative work up mitigates morbidity and shortens convalescence. APPROACH CONSIDERATIONS There are about three principles that can guides the choice of the thoracotomy incision to be used I. Adequate exposure must be achieved. The choice of incision is aided by a thorough understanding of the surface anatomy and a comprehensive review of the radiographic images that are obtained preoperatively. II. Chest-wall function and appearance should be preserved to the extent possible. This principle include non-spreading video-assisted thoracoscopic surgery (VATS) procedures, muscle-sparing techniques, avoidance of excessive rib retraction, and rib preservation when possible. III. The third principle is that closure must be meticulous and appropriate. Strict layered closure is the rule for thoracic surgical incisions. Every effort should be made to approximate the individual divided chest-wall muscles in appropriate layers; otherwise, a significant delay in the recovery of range of motion (ROM) may result. Care must be taken to avoid over approximating the ribs and to prevent an override; this will help minimize postoperative pain. POST-OPERATIVE CARE AND MONITORING

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