Introduction
- Aim
Either to control airway and improve ventilation during anesthesia/surgery
Or to establish a permanent opening to the trachea by bypassing the larynx to improve respiration (if laryngeal disease is causing severe interference with normal breathing patterns)
Or as an emergency procedure in eg laryngospasm, laryngeal foreign body or edema.
Uses
Advantages
- Can perform under sedation and local anesthesia in an emergency.
- May allow cat to continue with improved quality of life.
Ventilatory management
- Means of maintaining prolonged postoperative mechanical ventilation.
- Access to lower airway.
Production of chronic tracheal debris, eg blood or mucus, may require repeated aspiration.
Some foreign bodies may be removed from trachea via this route.
Bypass of upper airway obstructions
- Laryngeal injuries/obstruction , tracheal trauma.
- Nasomaxillary trauma or electrical/chemical burns.
- Neoplastic lesions, foreign bodies
. - Main indication in small animal practice is to facilitate anesthesia during upper airway surgery .
Requirements
Materials required
Minimum equipment
Tracheotomy- Basic cut-down pack.
- Tubes with a range of sizes: tube selected should be ~50% of the diameter of the trachea.
- Good illumination.
Tracheostomy tube
- May be made of nylon, PVC (or previously silver) .
- May be cuffed for inflation . The addition of a cuff allows for a complete seal to prevent aspiration of debris from the skin wound + ability to use positive pressure ventilation.
- Removable obturator allows easier introduction of tube into wound.
- Removable cannula allows inner sleeve to be removed for regular cleaning .
Ideal equipment
- Fine scissors for incising tracheal rings
. - Suction (trap bottle).
- ECG monitor .
Preparation
- Normal routine surgical preparation of ventral neck.
- In an emergency clip hair but do not delay by scrubbing skin.
Sequelae
Complications
- Tube dislodged/obstructed .
- Subcutaneous emphysema, pneumomediastinum/pneumothorax.
- Tracheal stenosis.
- Tracheomalacia (ischemic necrosis of tracheal tissue due to surgical damage or repeated abrasion from tracheostomy tube).
- Aspiration.
- Infection .
Prognosis
- Depends on reason for insertion of tube.
Reasons for treatment failure
- Sedation alone may leave animal struggling against attempts to help → acute deterioration and death.
Consider a careful general anesthetic for placement . - Exuberant granulation at site of tracheotomy.
- Tracheal stenosis.
- Tracheomalacia.
- Tracheobronchial fistula.
Sources
Publications
- Hedlund C S (1994) Tracheostomies in the management of canine and feline upper respiratory disease. Vet Clin North Am Small Anim Pract 24 (5), 873-886.
