A tracheostomy is a surgically created opening in the trachea to allow for an alternative airway. It has several functions including improving breathing, protecting the airways from aspiration, allowing for suctioning of secretions, and enabling positive pressure ventilation. Tracheostomies can be emergency procedures for acute airway obstruction or elective for longer term issues. The procedure involves making an incision in the neck, separating tissues and strap muscles, opening the trachea, and inserting a tracheostomy tube. Post-operative care focuses on suctioning, tube care, and prevention of complications like infection, bleeding, or stenosis. Tracheostomies may be temporary or permanent depending on the underlying condition.

1. TRACHEOSTOMY & Tracheal
Surgeries
S.SUKRUTH

2. Definition
A tracheostomy is a artificial (usually) surgically
created airway fashioned by making a hole in the
anterior wall of the trachea and the insertion of a
tracheostomy tube, which may or may not be
permanent

3. Functions of Tracheostomy
1. Alternative pathway for breathing
2. Improves alveolar ventilation In cases of respiratory insufficiency :
(a) Decreasing the dead space by 30-50% (normal dead space is 150
ml).
(b) Reducing the resistance to airflow.
3. Protects the airways By using cuffed tube, tracheobronchial tree is
protected against aspiration of:
(a) Pharyngeal secretions, as in case of bulbar paralysis or coma.
(b) Blood, as in haemorrhage from pharynx, larynx or maxillofacial
injuries. With tracheostomy, pharynx and larynx can also be packed to
control bleeding.

4. 4. Permits removal of tracheobronchial secretions
When patient is unable to cough as in coma, head injuries,
respiratory paralysis; or
when cough is painful, as in chest injuries or upper
operations, the tracheobronchial airway can be kept clean of
secretions by repeated suction through the tracheostomy,
avoiding need for repeated bronchoscopy or intubation
is not only traumatic but requires expertise.
5. Intermittent positive pressure respiration (IPPR)
If IPPR is required beyond 72 hours, tracheostomy is
superior to intubation.
6. To administer anaesthesia
laryngopharyngeal growths or trismus.

5. Indications of Tracheostomy
A. Respiratory obstruction.
B. Retained secretions.
C. Respiratory insufficiency.

6. Types of Tracheostomy
 Emergency tracheostomy
 Elective or tranquil tracheostomy
 Permanent tracheostomy
 Percutaneous dilatational tracheostomy
 Mini tracheostomy (cricothyroidotomy)

7. 1. Emergency tracheostomy
 It is employed when airway obstruction is complete or
almost complete and
 There is an urgent need to establish the airway.
 Intubation or laryngotomy are either not possible or feasible
in such cases.

8. 2. Elective tracheostomy
(syn. tranquil, orderly or routine tracheostomy)
 This is a planned, unhurried procedure
 It is of two types:
(a) Therapeutic: to relieve respiratory obstruction, remove
tracheobronchial secretions or give assisted ventilation.
(b) Prophylactic: to guard against anticipated respiratory obstruction or
aspiration of blood or pharyngeal secretions such as in extensive surgery of tongue,
floor of mouth, mandibular resection or laryngofissure

9. 3. Permanent tracheostomy
 Required for case of bilateral abductor paralysis or laryngeal
stenosis.

10. Technique
 Whenever possible, endotracheal
intubation should be done before
tracheostomy. This is specially important in
infants and children.
 Position
Supine with a pillow under the shoulders so
that neck is extended.
Anesthesia
2 % lignocaine & 1 in 2 lakh adrenaline
injected into incision line

11. Steps Of Operation
1. A vertical incision in the midline of
neck, extending from cricoid
cartilage to just above the sternal
notch.
This is the most favoured incision and
can be used in emergency and
elective procedures. It gives rapid
access with minimum of bleeding
and tissue dissection.

12.  2. After incision, tissues are dissected in the midline. Dilated veins are
either displaced or ligated.

13.  3. Strap muscles are separated in the midline and retracted laterally.
 4. Thyroid isthmus is displaced upwards or divided between the clamps, and suture-ligated.

14. 5. 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 into a circular opening. The first tracheal ring is never
divided as perichondritis of cricoid cartilage with stenosis can result
6. Tracheostomy tube of appropriate size is inserted and secured by tapes
Lubricated tracheostomy tube inserted into trachea
Confirm presence of tube in trachea with help of ambu bag & auscultation

15.  7. Skin incision should
not be sutured or
packed tightly as it may
lead to development of
subcutaneous
emphysema.
8. Gauze dressing is
placed between the skin
and flange of the tube
around the stoma
Pic - Betadine soaked gauze or Sofratulle put
around the tracheostomy opening.

16. 9.Tapes of tracheostomy tube tied around the neck keeping a space
for 1 finger. Neck kept flexed.
Skin incision closed loosely to avoid surgical emphysema.

17. Post Operative Care
 1.Constant Supervision
 2.Suction
 3.Tracheostomy tube care
 4. Others
 5.Prevention of crusting and tracheitis

19. Decannulation
 Adult: plug or seal tube opening & if tolerated for 24 hrs, remove tube.
 Child: Sequentially reduce size of tube. After tube removal  close wound.
Healing occurs within 1 week. Secondary closure after freshening the wound
margin is required rarely.
 Infant or a young child
-Decannulate in operation theatre
-Equipment for re-intubation should ne available like good headlight,
laryngoscope, proper sized endotracheal tubes and a tracheostomy tray
-After decannulation observe for respiratory distress,t achycardia, colour.
-Oximetry is useful

21. Complications of tracheostomy
IMMEDIATE
(at time of operation)
INTERMEDIATE
(first few days or days)
LATE
(prolonged use of tube)
Haemorrhage Bleeding Haemorrhage
Apnoea Displacement of tube Laryngeal stenosis
Pneumothorax Blocking of tube Tracheal Stenosis
Injury to recurrent
laryngeal nerves
Subcutaneous
Emphysema
Tracheooesophageal
Fistula
Aspiration of blood Tracheitis &
Tracheobronchitis
Problems of
decannulation
Injury to oesophagus Atelectasis & lung abcess Problems of
tracheostomy scar
Local wound infections &
granulations
Persistent
tracheocutaneous fistula

22. Procedure for immediate airway
management
 JAW THRUST
 OROPHARYNGEAL AIRWAY
 NASOPHARUNGEAL AIRWAY (TRUMPET)
 LARYNGEAL MASK AIRWAY
 TRANSTRACHEAL JET VENTILATION
 ENDOTRACHIAL INTUBATION
 CRICOTHYROTOMY/LARYNGOTOMY/MINI TRACHEOSTOMY
 EMERGENCY TRACHEOSTOMY

23. Jaw thrust

24. Oropharyngeal Airway

25. Nasopharyngeal Airway (Trumpet)

26. Laryngeal Mask Airway

27. Transtracheal Jet ventilation

28. Endotracheal Intubation

29. Cricothyrotomy/Laryngotomy/Mini
tracheostomy

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