Perioperative management - Open tracheostomy - general and visceral surgery
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Indications
- Prolonged mechanical ventilation for more than 21 days.
- Airway obstruction, e.g., due to injury or tumor
- Compared with translaryngeal intubation, open tracheostomy offers these benefits: – avoids injury to the arytenoid cartilages
– avoids mucosal lesions at the vocal cords and trachea as well as in mouth and nose
– reduces airway resistance (decreases the work of breathing)
– decreases dead space
– better securing option
– easier oral hygiene
– less analgesics and sedatives needed
– more convenient for patient (can speak and ingest oral diet, no foreign-body feeling)
– enables or facilitates weaning
Contraindications
- Infection at the planned incision site
- Unstable cervical spine
- Coagulation disorders
- Massive gas exchange disorders
Preoperative diagnostic work-up
- Coagulation panel
- Bronchoscopy
Special preparation
None
Informed consent
- Bleeding
- Infection
- Tracheal injury
- Possible necessity of revision surgery
- Pneumothorax
- Injury to the recurrent nerve
- Cutaneous/mediastinal emphysema
- Scar formation at the tracheostomy
- Cardiac arrest by vagal stimulation
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative management
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