Dr. Maleka Afroz discusses tracheostomy, listing its indications such as bypassing airway obstruction from larynx cancer or for tracheobronchial toiletting in acute laryngotrachealbronchitis. Tracheostomy may also be used to protect the tracheobronchial area in unconscious patients, for patients on ventilators in the ICU, or for those with respiratory insufficiency from COPD. It can be done as a temporary procedure prior to head/neck surgery or permanently prior to total laryngectomy. The document outlines the different types of tracheostomy as emergency, elective or permanent and reviews causes for airway obstruction. Steps for the tracheostomy operation are

1. Dr.Maleka Afroz
Associate Professor, ENT
USTC, Foy’s Lake Chittagong

2. 
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Endotracheal intubation
Laryngotomy or Cricothyrodotomy
Tracheostomy

4. 
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To bypass Airway obstruction (Ca larynx)
Tracheobronchial toiletting (Acute
laryngotrachealbronchitis,neuroparalysis)
Tracheobronchial protection (Unconscious patient)
Patient on ventilator ( ICU)
Patients with respiratory insufficiency ( COPD)
Prior to radical Head- neck or Maxillofacial surgery
as a temporary procedure
Prior to total laryngectomy as a permanent
procedure

5. 
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Emergency
Elective
Permanent

6. Obstructive –Congenital
Acquired-Traumatic
Inflammatory
Neoplastic
F.B. in larynx
Paralytic
Allergy
Non obstructive-Mentioned earlier.

7. 
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A little variation is marked in the operative
techniques between emergency, elective
&permanent procedure.
As well as between child & adult
tracheostomy.

8. Steps of Tracheostomy Operation

9. 
Metallic- Outer & inner tube without cuff
though reusable.

Portex- Single tube with or without cuff,
disposable.

12. 
Care of the tube-Constant supervision for
tube blockage or tube displacement, Inner tube,
Outer tube, Cuff, Suction clearance, Humidification.
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Care of the wound-Regular dressing.
Care of the patient- Breathing exercise, Pen
& Paper, Bell.

13. 
Immediate- Hemorrhage, Aphonia, Apnoea, Injury to
Structures around (apical pleura, nerve, esophagus,
cricoid cartilage, fist tracheal ring), surgical emphysema,
Tube displacement.

Intermediate- Tube blockage, Chest infection, wound
infection.

Late- Layrngeal stenosis, Tracheal stenosis, Tracheo
oesophageal fistula, Tracheo cuteneous fistula, Difficult
decannulation.