Tracheostomy

Tracheostomy is one of the oldest documented surgical procedures and was initially used to relieve upper airway obstruction, principally associated with acute airway infections. Tracheostomy should be performed as an elective procedure using the conventional dissection technique. The operation is performed under general anesthesia. Children are usually intubated, but in cases where intubation is deemed impossible a laryngeal mask airway may be used, or even a facemask. Retraction of the strap muscles reveals the pre-tracheal fascia and thyroid isthmus joining the two lobes of the thyroid gland. Above the isthmus, the cricoid is seen, although in the neonate it is easier to identify by palpation, feeling for its prominence with fine curved “mosquito” artery forceps. Careful hemostasis is achieved, the cricoid is identified, and the tracheal rings are counted. The first tracheal ring must not be included in the tracheostomy, and in neonates and infants, where distances are small it is preferable to preserve the second ring as well.