Laryngeal Paralysis Surgical Option 2. Tracheostomy

Question 1

Temporary Tracheostomy

Answer 1

performed when the animal is suddenly unable to breathe

Question 2

Permanent Tracheostomy

Answer 2

performed when the patient is suffering from severe laryngeal paralysis and the other surgical options have failed

Question 3

What two procedures are done for a tracheostomy

Answer 3

Permanent and temporary

Question 4

What is the tracheostomy procedure

Answer 4

1. Ventral midline incision into the skin and muscle layer to expose trachea.
2. Transverse incision is made into the 4-6th tracheal ring.
3. A stay suture is place cranial and caudal to the incision.
4. The stay suture is placed in case the tracheostomy tube comes loose, then the sutures can be pulled apart to provide an immediate opening.
5. The tracheostomy tube is inserted into the trachea.
6. The muscle layer is then closed using loose simple interrupted absorbable sutures
7. Routine skin closure.
8. A loose simple interrupted suture using non absorbable material is placed around the cuff on either side of the tube and sutured to the skin.
9. Umbilical tape is then placed through the cuffs of the tube and then tied around the neck of the patient.
10. The wound is left to heal by secondary intention

Question 5

When can a temporary tube be removed?

Answer 5

24-48 hours after surgery, if the patient can breath without the aid of the bypass tube.

Question 6

Preoperative care

Answer 6

Pre oxygenation
Keep the patient in sternal recumbency for maximum oxygenation or allow the animal to assume a comfortable natural position themselves

Question 7

Patient Prep

Answer 7

Clip should extend from the LARYNX to the EIGHTH tracheal ring, and the skin prepped aseptically

Question 8

Patient Postioning

Answer 8

Placed in dorsal recumbency with the neck extended over a support bag/ towel.
IMPORTANT that patients are kept straight and symmetrical as possible. Limbs should be secured with ties

Question 9

Instruments / Materials

Answer 9

General surgical kit
Two self retaining retractors (gelpies placed cranial and caudal)
Sterile tracheostomy tube
Non absorbable sutures
Four quarter drape

Question 10

Post op care

Answer 10

Constant monitoring for 12-24 hours post surgery
The tube needs suctioning every hour to remove mucous build up
The tube needs humidification
Tracheostomy tube changed every 2-6 hours

Question 11

Post op complications

Answer 11

wound dehiscence
Inflammation of the larynx
Aspiration pneumonia

Question 12

Life long care

Answer 12

No swimming
hair around the tube kept short and the site clean
harness no collar