What Is Median Sternotomy?

Tracheostomy is an incision of the cervical trachea and the placement of a metal tracheal tube and a silicone tube. It is a common operation to relieve dyspnea caused by laryngeal dyspnea, respiratory dysfunction, or retention of lower respiratory secretions.

Basic Information

Chinese name: Tracheotomy
Anesthesia: Local or general anesthesia

Indication: Laryngeal obstruction, retention of lower respiratory tract secretions, etc.
Contraindications: Tension pneumothorax, hypovolemic shock, etc.

Tracheotomy anesthesia

In the past, it was often local anesthesia (referred to as local anesthesia). At present, general anesthesia is selected from the perspective of medical safety (general anesthesia), and tracheostomy is performed under general anesthesia after tracheal intubation.

Preparing for tracheotomy

For severe breathing difficulties, prepare tracheal intubation. If breathing stops during tracheotomy, intubate immediately, or intubate before tracheotomy to avoid accidents during surgery.

Indications for tracheostomy

1. Laryngeal obstruction: severe laryngeal obstruction caused by inflammation of the throat, tumor, trauma, foreign body, etc.
2. Retention of lower respiratory tract secretions: retention of lower respiratory tract secretions due to various reasons (traumatic brain injury, thoracic and abdominal trauma, and polio, etc.) In order to suck sputum and keep the airway open, tracheotomy can be considered.
3. Preventive tracheotomy: pharyngeal tumors, abscesses with dyspnea; for major oral, nasopharyngeal, maxillofacial, pharyngeal, and larynx major operations, in order to perform general anesthesia to prevent blood from flowing into the lower respiratory tract during and after surgery To keep the airway unobstructed after operation; to prevent bleeding or local tissue swelling in the operation area to prevent breathing, tracheotomy can be performed.
4. Tracheal foreign body removal: Unsuccessful forceps under endoscopy, it is estimated that there is a risk of suffocation, or those who do not have bronchoscopy equipment and techniques, can remove the foreign body through the tracheotomy (rarely).

Contraindications for tracheostomy

1. Patients with tension pneumothorax (can go on the machine after intubated closed drainage).
2. Hypovolemic shock, heart failure, especially right heart failure.
3. Pulmonary bullae, pneumothorax, and mediastinal emphysema are not drained.
4. Patients with massive hemoptysis.
5. Myocardial infarction (cardiogenic pulmonary edema).

Tracheostomy surgery steps

1. Posture: Generally take the supine position, place a small pillow under the shoulders, tilt your head back, make the trachea close to the skin, and expose it obviously to facilitate the operation. The assistant sits on the side of the head to fix the head and maintain the center position. Routine disinfection, lay sterile towels.
2. Local anesthesia: along the middle of the front of the neck, from the lower edge of the thyroid cartilage, down to the upper sternal fossa, infiltration anesthesia with lidocaine, for coma, critically suffocated or suffocated patients, if you are unconscious, you may not be anesthetized.
3. Incisions: Straight incisions (transverse incisions can be used for general anesthesia patients), from the lower edge of the thyroid cartilage to the upper sternal fossa, and cut the skin and subcutaneous tissue along the front midline of the neck.
4. Isolate the pretracheal tissue: Use vascular forceps to separate the sternohyoid muscle and sternum thyroid muscle along the midline to expose the thyroid isthmus. If the isthmus is too wide, you can separate it slightly at its lower edge, and pull the isthmus upward with a small hook, if necessary. The isthmus can also be clipped and sutured to expose the trachea. During the separation process, the two hooks should be applied evenly to keep the surgical field at the centerline, and often use fingers to check whether the ring-shaped cartilage and trachea remain in the center position.
5. Incision of the trachea: After the trachea is determined, generally at the 2nd to 4th tracheal rings, use a pointed blade to cut 1 to 2 anterior walls of the tracheal ring from the bottom to the top to form the anterior tracheal flap (cut 4 to 5 rings). (Lower tracheostomy), after the intubation is fixed subcutaneously (when the tracheal tube comes out after surgery, it is beneficial to the tracheal tube insertion), do not insert the blade too deep, so as not to puncture the back wall of the trachea and the anterior esophagus Causes tracheoesophageal fistula.
6. Insert tracheal cannula: use a curved forceps or tracheal incision dilator to open the tracheal incision, insert a tracheal cannula with a suitable size and a core, after inserting the outer tube, immediately remove the tube core, put it into the inner tube, and suck it out. Discharge and check for bleeding.
7. Wound treatment: Tie the strap on the tracheal tube to the neck and tie it into a knot to secure it firmly. The incision is generally not sutured to avoid subcutaneous emphysema. Finally, an open gauze pad is placed between the wound and the cannula.

Tracheotomy complications

1. Postoperative bleeding.
2. Pneumothorax and mediastinal emphysema.
3. Subcutaneous emphysema.
4. Difficulty in extubation.
5. Incision infection.
6. Casing comes out.
7. Sudden respiratory arrest.
8. Tracheoesophageal fistula.
9. Laryngeal trachea is narrow.
10. Difficulty in extubation.
11. Rare complications, such as recurrent laryngeal nerve paralysis and air embolism.

Tracheostomy considerations

1. Always keep the incision in the middle position. The hook must be lifted up evenly to ensure that the incision is cut in the middle.
2. The tracheal tube should be provided with a balloon to prevent vomit from being inhaled into the respiratory tract by mistake, which is also conducive to respiratory management.
3. The tracheal secretions should be sucked up immediately when the trachea is cut; oxygen should be supplied immediately after the operation, pay attention to the humidification of the airway or use ultrasonic atomization for regular inhalation.
4. The inner tube must be cleaned and disinfected once a day, and the inner tube replacement and sputum suction should be strictly aseptic.
5. Timing deflation tube cuff.

Nursing after tracheotomy

1. Adjust the elasticity of the casing tie at any time.
2. Observe the breathing condition closely to make the air flow smoothly. Do not cover the sleeve with the bedding; wipe off the secretions from the mouth of the sleeve at any time. Periodic drip or nebulization in the trachea. A single-layer saline gauze humidifies the mouth of the cannula.
3. Remove and clean the endotracheal tube every 12 to 24 hours after surgery. If there is noise or obstruction in the tracheal tube, the tracheal tube must be aspirated at any time or replaced in time, otherwise the blockage of the tube is dangerous to life.
4 Take care to prevent the casing from coming out.