Tracheotomy

Index

  1. What is tracheotomy?
  2. Why is it performed?
  3. What does it consist of?
  4. Preparing for tracheostomy
  5. Care after the operation

What is tracheotomy?

Tracheostomy is one of the oldest procedures and involves opening the trachea through an opening in the neck. A tube (tracheostomy cannula or tracheal tube) is usually placed in the trachea so that the patient can breathe and secretions are removed from the lungs.

This creates a bypass and prevents inflammation or a blockage in the mouth or throat.

A tracheostomy involves a 1.5 cm incision
of about 1.5 cm in the neck

Why is it performed?

It is usually done for obstruction at the level of the oropharynx, larynx or upper part of the trachea. Other cases in which it is performed are:

  • Prolonged intubation, where the patient is on prolonged mechanical ventilation.
  • Aspiration of pulmonary secretions, such as mucus in the airways and lungs.
  • Permanent swallowing deficits.
  • Complex head or neck surgeries.
  • Hereditary abnormality of the trachea or larynx.
  • The patient has inhaled smoke, vapor or toxic gases that have swollen and blocked the airways.
  • The patient has cancer of the neck, which puts pressure on the airway.
  • He suffers from paralysis of the muscles and cannot swallow.
  • He presents a severe trauma to the neck or head that prevents breathing.

Depending on the cause, we differentiate between emergency tracheostomy, emergency tracheostomy and tracheostomy of choice. In addition, it can be temporary or permanent.

What does it consist of?

Tracheostomy consists of opening a hole in the trachea to prevent asphyxia. For this, an incision of about 1.5 cm is made in the neck, in front of the trachea; then the trachea is punctured and dilated until the tube can be inserted. The procedure usually takes no more than 10 minutes and requires general anesthesia.

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This technique may carry some risks (in addition to those involved in surgery and anesthesia) such as damage to the thyroid, erosion of the trachea, puncture of the lung and lung atelectasis, and scar tissue in the trachea causing pain or difficulty breathing.

Preparation for tracheostomy

It is usually performed under anesthesia, unless it is an emergency tracheostomy, as there is usually no margin for it. In the emergency technique, an anesthetic is usually applied to the area so that the patient does not suffer pain, while in the tracheotomy of choice, general anesthesia is used.

When general anesthesia is required, the specialist may recommend avoiding eating and drinking during the hours prior to the procedure, as well as not taking certain medications.

Post-procedure care

A person with a tracheotomy should be careful with the hygiene of the area, and be prepared to know how to react in case of partial or total obstruction of the cannula. In addition, exposure to aerosols or airborne particles should be avoided to prevent them from entering the airway.

Normally, tracheostomy prevents speaking, as the exhaled air exits through the tracheostomy opening instead of going up through the larynx, so there are devices and techniques to redirect this airflow to allow speaking. Also, during recovery swallowing will be difficult, so when you are ready you may need to work with a speech therapist who will help regain muscle strength and swallowing coordination.

If the tracheostomy is temporary the cannula will be removed, while if it is permanent the hole will remain open.