Tracheotomy is what? Technique of tracheotomy

In surgery, there are two concepts - tracheotomy and tracheostomy.

Tracheotomy is the opening of the trachea and the insertion of a tube into it to allow air to enter the lower respiratory tract during asphyxiation. This is an emergency operation.

Tracheostomy is also an opening of the trachea, but with the hemming of the resulting incision to the underlying tissues and the formation of a hole for breathing.

A bit of history

This method of emergency care was already known in ancient Egypt and India, there is documentary evidence that it was used even by Alexander the Great to save soldiers in his army. This procedure was written by Hippocrates and Gallen, but because of her traumatic and life-threatening, it was not recommended to use it often in practice.

The first successful operation was performed by the Italian physician Antony Brasavola in 1546. This is the first documented evidence that after the manipulation the patient remained alive. Since 1718 this type of surgical intervention has become ordinary and is being used by doctors more widely. And yet many still were afraid to use it. For example, George Washington's personal doctor preferred that his patient die, than he decided to make risky manipulation.

The emergence of aseptic and antiseptic rules slightly reduced the risk of complications and mortality, but still did not convince the medical community that this method is safe for the patient. Currently, tracheotomy is an emergency method of care, which is used only when all other methods (Heimlich's method, intubation) are ineffective or they do not have time.

Indications for surgery

No matter how simple the tracheotomy seemed, the testimony for it is quite strict, since the risk to human life during this manipulation exceeds the possible benefits. It:

1. Foreign bodies located above the trachea, which can not be removed by other means.
2. Closed injuries, narrowing the laryngeal lumen.
3. Acute stenosis of the larynx with diphtheritic croup, pertussis, measles, typhus, etc.
4. Interlacing the lumen of the trachea or larynx with a tumor.
5. Compression of the upper respiratory tract from the outside.
6. Chemical burns
7. Allergic stenosis.

Types of obstruction of the respiratory tract

• The sharpest, or lightning, - develops literally in a few seconds. This can be as a blockage of foreign bodies, as well as allergic edema.
• Acute - manifests itself in a matter of minutes, usually associated with diphtheria or foreign bodies.
• Subacute - closing the lumen of the airways can last dozens of minutes, and even hours. This condition is typical for false croup, sore throat, chemical burns.
• Chronic - can grow for years in such pathological processes as larynx cancer, perichondritis, cicatricial narrowing of the trachea.

Classification

There are several types of tracheotomy, depending on the technique of its conduct.

Cutting level:

• Upper: at the level of the cricoid cartilage.
• Average: at the level of the thyroid cartilage.
• Lower, or conicotomy.

According to the nature of the section:

• Longitudinal.
• Transversal.
• U-shaped.

Instruments

Do not forget that for all its urgency and improvisation, this technique is positioned as an operation. Tracheotomy should be performed by a specific set of instruments, if any. Conditionally they can be divided into two large groups: these are general surgical tools and specialized ones.

The first group includes tweezers, a scalpel, clamps for stopping blood, surgical scissors, hooks for breeding tissues, a catheter, syringes and needles. The second group includes the tracheotomy cannula of Luer, consisting of two tubes located one in the other; Chassignac's hook, designed to hold the trachea without traumatizing it; Trachea dilator and hook for pushing the isthmus of the thyroid gland.

Technique of tracheotomy

Before any operation, appropriate training is carried out, which helps the doctor as soon as possible and painless for the patient to make the necessary intervention. In this case, it is necessary to put the patient on his back and tilt his head back as much as possible so that the cartilages of the trachea can be clearly seen. For this, a roller is sometimes used. After fixation, a person gets anesthesia. It can be either general inhalation or local. It all depends on the conditions in which the operation is performed, the age of the patient, the capabilities of the doctor and the hospital. If the situation is urgent, the doctor conducts the manipulation without anesthesia. After all preparations, the tracheotomy begins immediately.

The technique of implementation consists in a stratified cut of the skin, subcutaneous fat, fascia and fibrous membrane down from the thyroid cartilage. Then a muscle is exposed, which is diluted in a blunt way. Under it is the cartilage and isthmus of the thyroid gland. The iron is separated from the trachea and moved back up, dissecting another fascia. Hook fix the larynx and, by limiting the scalpel blade with a finger, bandage or plaster, make a small incision. The goal is achieved. The air again gets into the lungs. First, a breath may stop, but then the patient begins to cough and turn pink. Only after the doctor was convinced that the person again began to breathe, a cannula is inserted into the wound and fixed with sutures or plaster. The wound is sewn so that it holds the tube tightly.

Conicotomy

This is a small operation that precedes the tracheotomy, if there is no possibility and time to conduct a normal tracheotomy. Performing it, no longer do step-by-step incisions. One movement cuts the neck down to the cricoid cartilage and the thyroid-sacrificial ligament. Insert a clip into the incision, dilute its jaws and fix them in this position. If the patient started to breathe, turned pink, had a cough, then the procedure was successful. Once the danger has passed, it is possible to translate the conicotomy into a tracheostomy, in order to ensure a constant influx of air for the patient.

Possible errors during the manipulation

Any operation has its consequences, tracheostomy is not an exception. The complications that arise in connection with it can be divided into three groups.

1. During the operation:

• The wrong line of the incision can cause venous bleeding, air embolism, and sometimes the cutting of the common carotid artery ;
• Blood can enter the lower respiratory tract, causing repeated asphyxia;
• The incision should be equal to the diameter of the cannula, otherwise it will have to be sewn up and further injure the tissues;
• A deep incision can cause an injury to the esophagus, so the scalpel blade should be limited to 1 cm.

2. Immediately after the operation:

• Hypoxia;
• Fracture of the tracheal ring or its puncture;
• Subcutaneous emphysema;
• pneumothorax.

3. Delayed consequences:

• Tracheobronchitis;
• Stenosis of the trachea and repeated asphyxia;
• Change (hoarseness) of the voice due to the cutoff of the recurrent nerve;
• Cosmetic defects.

All the doctors still remember from the student's bench how dangerous the tracheotomy is. This is not an operation that can be carried out continuously. Only in emergency, special cases, when the patient is on the verge of life and death, because in a hurry, it can be harmful to the patient. And if this manipulation is not carried out in a hospital, but somewhere on the street or at home, then it is worth a hundred times to think before deciding. A simple, at first glance, technique should be supported by a sufficient surgeon's experience. Tracheotomy at home is not just impossible, it is dangerous. If you do not have medical education and relevant skills, do not try to repeat it.

Tracheotomy is advisable only to save a person's life! The risk of a fatal outcome or the development of serious complications is high enough to force a doctor to think about alternative options. Even considering that this operation is known from time immemorial, the medical community has not yet figured out how to make it safe enough.

A tracheotomy is an opportunity to save someone's life, but at the same time an equal opportunity to take it away.