Special Surgical Procedures II LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery Section IV: THROAT, TONGUE, AND NECK SURGERY
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1-38. ELECTIVE TRACHEOSTOMY
a. General. This procedure involves opening the trachea and inserting a cannula through a midline incision in the neck, below the cricoid cartilage. It is used as an emergency procedure to treat upper respiratory tract obstruction and as a prophylactic measure in the presence of chronic lung disease in which an obstruction could occur. A prophylactic tracheostomy is performed at the time of surgery, thus providing for easy and frequent aspiration of the tracheobronchial tree and diminishing the dead space that exists from the opening of the mouth down to the supraclavicular region. The creation of a new clearance (tracheostomy) nearer to the functional areas in the lung provides for greater volume of air for the patient with a partly destroyed lung. Anesthesia may be maintained via a prophylactic tracheostomy.
b. Preparation of the Operating Room. The standard instruments and other items needed are kept sterile in a pack, ready for immediate use. In addition, the circulator is to have a cardiac arrest tray immediately available.
c. Preparation of the Patient. The patient is placed in a dorsal recumbent position, with the shoulders raised by a folded sheet to hyperextend the neck and head. The neck is cleansed and sterile drapes applied as for operations of the thyroid.
d. Operative Procedure.
Figure 1-12. Metal tracheostomy tube. A-Parts of a metaltracheostomy tube. B-Tracheostomy ties and gauze pants in place.
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