Presentation on Tracheostomy

1. Tracheostomy
PRESENTER: JONATHAN IRIBUKA

2. OUTLINE
• Introduction
• Functions of tracheostomy
• Indications
• Contraindications
• Types
• Technique
• Postoperative care
• Complications
• references

3. INTRODUCTION
• Tracheostomy is making an
opening in the anterior wall of
trachea and convert it into a
stoma on the skin surface.
• As tracheostomy is a complex
procedure, it is preferably done in
operating room with adequate
room and assistance.

4. Functions of tracheostomy
Provides alternative pathway for breathing
Improves alveolar ventilation
By using cuffed tube, the airways are protected against aspiration of pharyngeal
secretion in case of coma or blood in case of trauma.
Tracheostomy allows removal of tracheobronchial secretions
If intermittent positive pressure respiration (IPPR) is required above 72 hours,
tracheostomy is better than intubation

5. Indications of tracheostomy
• Congenital anomaly (e.g., Laryngeal hypoplasia, vascular web)
• Upper airway foreign body that can not be dislodged with Basic life support maneuvers
• Supraglottic or glottic pathologic conditions
• Neck trauma that results in severe injury to the thyroid or cricoid cartilages, hyoid bone or
great vessels
• Subcutaneous emphysema
• Facial fractures that may lead to obstruction
• Aspiration and inability to handle secretions

6. Contraindications of tracheostomy
Generally, no absolute contraindications but some patients are not favorable candidates.
These includes patients with:
• Obesity
• Abnormal or poorly palpated midline neck anatomy
• Coagulopathies
• Enlarged adenoids
• Also pediatric patients

7. Types of Tracheostomy
1. Emergency tracheostomy: used when there is life threatening obstruction and there is
urgent need to establish airway
2. Elective tracheostomy: Planned and unhurried, it has Therapeutic and prophylactic
subtypes.
3. Permanent tracheostomy: done especially for bilateral abductor paralysis or laryngeal
stenosis
4. Percutaneous dilatational tracheostomy:
5. Mini tracheostomy (cricothyroidotomy)

8. Technique
Following induction of general anesthesia and
endotracheal intubation, the patient is
positioned with a combination of head
extension and placement of an appropriate
sandbag under the shoulders. There should be
no rotation of the head.

9. Technique (cont.)
1. A vertical incision is made in the midline of the neck, extending from cricoid cartilage to above the
sternal notch.
2. Tissues are dissected in midline
3. Strap muscles are separated in the midline and retracted.
4. Thyroid isthmus is displaced upward or divided, and suture ligated
5. A few drops of 4% lignocaine are injected into trachea to suppress cough
6. Trachea is fixed with hook and opened in the region of 3rd and 4th or 3rd and 2nd rings
7. Tracheostomy tube is placed, With the tube in place, it is connected to the anesthesia circuit, and
end-tidal CO2 confirmed. Only then is the cricoid hook released.
8. Skin should not be sutured or packed tightly to avoid subcutaneous emphysema
9. Gauze dressing is placed between skin and flange of the tube around the stoma.

10. Technique (cont.)

11. Postoperative care
● Suction – efficient, sterile and as often as required
● Humidification (with or without oxygen)
● A warm, well-ventilated room
● Position of the tube and patient
● Spare tube, introducer, tapes, tracheal dilator
● Change of tube, inner tube, possible speaking valve
● Physiotherapy
● Initiation of local decannulation protocols where indicated

12. Complications

13. References
• Bailey & love’s short practice of surgery 27th edition
• Medscape
• Lecture notes on diseases of the ear, nose and throat 9th edition
• Tracheostomy in Adults – DynaMedex
• Tracheostomy (youtube.com)