Anesthetize the skin at the planned tracheotomy site with mepivacaine 1% and 1:100,000 epinephrine (about 5 ml).
The skin will become ischemic and turn white; this will lessen any bleeding.
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Local anesthesia of the surgical field
![Local anesthesia of the surgical field]()
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Bronchoscopic overview
![Bronchoscopic overview]()
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Remark: Since this is a text-to-speech computer voice, it may mispronounce some medical terminology.Tracheal assessment Pull back the ventilation tube to the level of the vocal cords.
Transilluminate the site of the planned puncture from the lumen of the trachea with the light of the bronchoscope.
Tracheal puncture and introduction of the Seldinger guidewire
Puncture in a strictly median and slightly caudad direction.Concurrent bronchoscopic monitoring hel
Puncture in a strictly median and slightly caudad direction.Concurrent bronchoscopic monitoring hel
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