Page 114 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 8 · Surgery of the extrathoracic trachea

Tracheostomy
VetBooks.ir Temporary tracheostomy

Placement of a temporary tracheostomy is indicated for
emergency management of upper airway obstruction
pending:
• Appropriate patient stabilization
• Definitive surgical correction of the upper airway (e.g.
laryngeal paralysis requiring arytenoid lateralization
when an experienced surgeon was not initially available)
• Response to medical therapy and bypass of the airway
(e.g. severe airway swelling following anaphylaxis,
management of the surgical complication of airway
(a) swelling following upper respiratory tract surgery)
• Receipt of biopsy results from a lesion in the upper
respiratory tract.

Temporary tracheostomy is also indicated in a patient
that requires a prolonged period of assisted ventilation,
to avoid laryngeal trauma and reduce the depth of anaes-
thesia required by minimizing laryngeal stimulation. Patients
with maxillary and mandibular fractures may benefit from
temporary tracheostomy, rather than orotracheal intubation,
to facilitate accurate assessment of dental occlusion during
fracture reduction. Cuffed tracheostomy tubes would be
required in these situations.
Temporary tracheostomy is performed by creating a
transverse incision in the ventral tracheal wall, through one
(b) of the annular ligaments, at approximately the level of the
third to fifth tracheal ring. The incision should ideally be
(a) Lateral cervical and (b) thoracic radiographs of a cat that
8.4 developed extensive subcutaneous emphysema 10 days no greater than 50% of the tracheal circumference (Figure
following general anaesthesia for routine ovariohysterectomy. The cat 8.5). A step-by-step guide to the procedure is outlined in
had a tear in the dorsal tracheal ligament at the level of the thoracic inlet Operative Technique 2.1. Depending upon the size of the
consistent ith an in ury secondary to endotracheal tube cuff inflation. patient and/or the trachea, different trache ostomy tubes are

Temporary
8.5
tracheostomy
placement in a cat with upper
respiratory tract obstruction
secondary to laryngeal
inflammation. a tay sutures are
placed through the trachea
proximal and distal to the
proposed site of annular ligament
incision for the tracheotomy. (b) A
tracheotomy is performed using a
scalpel blade to incise through the
annular ligament. (c) Manipulation
of the stay sutures to open the
tracheostomy can aid insertion of
the tracheostomy tube. (d) The
(a) (b) tracheostomy tube is inserted and
will then be secured around the
neck of the cat using umbilical
tape.

(c) (d)

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