Tracheostomy procedure done by PROF.Rani Samsudin. Tracheostomy is an operative procedure that creates a surgical airway in the cervical trachea. The traditional semantic difference between tracheostomy and tracheotomy is blurred in this instance because the hole is variably permanent. If a cannula is in place, an unsutured opening heals into a patent stoma within a week. If decannulation is performed (ie, the tracheostomy cannula is removed), the hole usually closes in a similar amount of time. The cut edges of the tracheal opening can be sutured to the skin with a few absorbable sutures to facilitate cannulation and, if necessary, recannulation; alternatively, a permanent stoma can be created with circumferential sutures. The term tracheostomy is used, by convention, for all these procedures and is considered to be synonymous with tracheotomy INDICATION: the advent of the antibiotic era coupled with great advances in anesthesia have made tracheotomy or tracheostomy a commonly performed elective procedure. To bypass obstruction Congenital anomaly (eg, laryngeal hypoplasia, vascular web) Foreign body that cannot be dislodged with Heimlich and basic cardiac life support (BCLS) maneuvers Supraglottic or glottic pathologic condition (eg, infection, neoplasm, bilateral vocal cord paralysis) Neck trauma that results in severe injury to the thyroid or cricoid cartilages, hyoid bone, or great vessels. Subcutaneous emphysema Appears in face, neck, or chest Readily dissecting air, especially through inflamed or traumatized tissue planes, leading to massive soft tissue edema Facial fractures that may lead to upper airway obstruction (eg, comminuted fractures of the midface and mandible) Edema Trauma Burns Infection Anaphylaxis To provide a long-term route for mechanical ventilation in cases of respiratory failure To provide pulmonary toilet Inadequate cough due to chronic pain or weakness Aspiration and the inability to handle secretions (The cuffed tube allows the trachea to be sealed off from the esophagus and its refluxing contents. Thus, this intervention can prevent aspiration and provide for the removal of any aspirated substances. However, some would argue that the risk of aspiration is not actually lessened, as secretions can leak around the cuffed tube and reach the lower airway.) Prophylaxis (as in preparation for extensive head and neck procedures and the convalescent period) Severe sleep apnea not amendable to continuous positive airway pressure (CPAP) devices or other, less invasive surgery Posted by Dr.Abdulkadir Daaci

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