Perioperative management - Percutaneous dilatational tracheotomy - general and visceral surgery
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Indications
- Prolonged mechanical ventilation (> 10 days)
Benefits compared with intubation:
- No injury of the arytenoid cartilages
- Prevention of mucosal lesions (nose/mouth, vocal cords, trachea)
- Less airway resistance (decreased ventilatory effort)
- Less dead space
- Better fixation
- Easier oral care
- Less analgesics/sedatives required
- Better patient comfort
- Easier weaning
Contraindications
- Emergencies
- Difficult airways suspected
- Rather difficult or even impossible standard intubation
- Infection at the planned puncture site
- Difficult anatomical conditions (e.g., large goiter, head reclination not possible)
- Unstable cervical spine
- Coagulation disorders
- Need for permanent tracheostomy or patient discharged home > epithelialized permanent tracheostomy required
Preoperative diagnostic work-up
- Coagulation panel
- Bronchoscopy
Special preparation
Fiberoptic monitoring while puncturing the trachea is strongly recommended.
Informed consent
- Bleeding
- Infection
- Tracheal injury
- Surgical revision
- Pneumothorax
- Injury to the recurrent nerve
- Cutaneous emphysema (incl. mediastinal emphysema)
- Scarring of the tracheostomy
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative management
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