Tracheostomy

airway trauma closed loop communication shared airway tracheostomy ventilation Jun 20, 2024

🌟 What and why? 🌟
A tracheostomy involves creating a passage through the front of the neck into the trachea to allow placement of an endotracheal tube. Common reasons for tracheostomy include upper airway obstruction, prolonged mechanical ventilation, trauma, and major neck surgery. A tracheostomy may be temporary or permanent.

🔍 Intraoperative considerations: 🔍
📍 Position: Supine, head ring +/- pad under shoulders.
⏱️ Duration: 30 mins
🌬️ Airway plan: Requires good communication when transitioning from an oral ETT. A short, cuffed tube is used to secure the airway. Ensure the circuit can reach the front of the neck. Consider a sterile tube extension for the surgical team to handle. Surgeon will require oral ETT cuff deflate and tube withdrawal to place the tracheostomy tube.

💡 Expert tips:
Preoxygenate with 100% O2 and paralyse the patient. Use closed-loop communication! Have a bronchoscope ready to check position or troubleshoot.

🌟 Postoperative considerations: 🌟
💥 Pain: Minimal pain. Coughing can be an issue if sedation is reduced.
❗ Airway risks: Bleeding can occur from thyroid vessels. A dislodged tracheostomy is a true airway emergency and requires immediate attendance by an anaesthetist and surgical team.

🔄 Other:
Retraction sutures are usually placed to identify the tracheal opening in an emergency.

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Ref: Turner, Grant, 'Ear, nose and throat surgery', in Rachel Freedman, and others (eds), Oxford Handbook of Anaesthesia, 5 edn, Oxford Medical Handbooks (Oxford, 2022; online edn, Oxford Academic, 1 Nov. 2021), accessed 13 June 2024.

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