TRACHEOSTOMY

General Information

DEFINITION-Creation of an opening in the windpipe (trachea) that will function as an airway either temporarily or permanently. The opening bypasses obstructions that prevent air from being inhaled.

BODY PARTS INVOLVED-Windpipe; muscles, blood vessels and nerves in the neck.

REASONS FOR SURGERY

• Restoration of normal breathing.
• Control of secretions from the nose and throat, particularly in patients who are unconscious.
• Creation of an open airway in patients who require prolonged breathing assistance.

SURGICAL RISK INCREASES WITH

• Newborns and infants.
• Adults over 60.
• Obesity; smoking; poor nutrition.
• Recent illness, especially upper-respiratory infection.
• Alcoholism or chronic illness.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.

What To Expect

WHO OPERATES-Ear, nose and throat specialist or general surgeon.

WHERE PERFORMED-Hospital, outpatient surgical facility or emergency room.

DIAGNOSTIC TESTS-Blood and urine studies and x-rays of chest before and after (if necessary) surgery.

ANESTHESIA

• Local anesthesia (in emergencies) by injection.
• General anesthesia (when time allows) by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• An incision is made in the neck. The muscles and connective tissue around the windpipe are divided.
• A section at the front of the windpipe is cut free and removed.
• A tracheostomy tube is fitted into the opening in the windpipe to function as an airway. The patient will breathe through this tube as long as it is in place. Supplemental oxygen and mechanical assisted breathing can be supplied if necessary.
• The skin is closed around the tube with sutures or clips, which usually can be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Inadvertent damage to the vocal cords, vocal-cord nerves or esophagus.
• Scarring at the operative site causing closure of the tracheotomy.

AVERAGE HOSPITAL STAY-3 to 5 days, depending on underlying condition.

PROBABLE OUTCOME-Expect complete healing without complications. Allow about 2 weeks for recovery from surgery.

Postoperative Care

GENERAL MEASURES

• A hard ridge should form along the incision. As it heals, the ridge will recede gradually.
• Use a heat lamp or a warm compress to relieve incisional pain.
• Keep the surgical area dry.
• Consult a speech therapist if recommended by your doctor.

† You may use non--prescription drugs, such as acetaminophen, for minor pain.

ACTIVITY

• Return to daily activities and work as soon as possible to promote healing.
• Avoid vigorous exercise for 6 weeks after surgery.

DIET--Your doctor will recommend a diet.

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• You experience new symptoms, such as nausea or vomiting.
• Speech difficulties persist after a temporary tracheostomy tube has been removed.