Procedures Flashcards
Indications of tonsillectomy
Absolute:
- Suspected malignancy
- Hemorrhagic tonsillitis with uncontrollable hemorrhage
- Child with OSA
- As part of UPPP
Relative:
- Recurrent tonsillitis fulfilling
- Paradise criteria (>7x/year | >5x/year for 2 consecutive years | >3x/year for 3 consecutive years)
- Recurrent Quinsy >1/year
- Halitosis from tonsilloliths
Complications of tonsillectomy
Bleeding
Infx
Odynophagia
Referred otalgia
Dehydration due to poor oral intake
Anatomy of trachea
- 11.5cm long, 2.5cm diameter
- Extends from cricoid cartilage (C6)
to carina (T4-5) - Formed by 15 – 20 U-shaped cartilages
- Posterior wall formed by trachealis muscle – deficient of cartilage
Indications for tracheostomy
- Prolonged ventilation
- Respiratory disease
- Neurological disease
- Neuromuscular disease - Airway obstruction
- Infection (e.g. abscess, epiglottitis)
- Tumour
- Edema (e.g. anaphylaxis, angioedema)
- Maxillofacial and laryngeal trauma
- Foreign body
- Bilateral vocal cord paralysis
- Craniofacial abnormalities - Airway protection
- Massive bleeding
- Severe aspiration - Tracheobronchial toilet
- Surgical access
- Major head and neck cancer resection
- Facial fractures
Types of tracheostomy
- Percutaneous tracheostomy
- Open tracheostomy
- GA tracheostomy (stable)
- LA tracheostomy
- ‘Slash tracheostomy’
How to perform an open tracheostomy?
Position: supine with shoulder roll
Incision: 2FB above sternal notch
Horizontal skin incision
Other types of acute surgical airway access
Cricothyroidotomy
- Only lasts for 30-45 mins
- Helps to push oxygen into the lungs but cannot breathe out CO2
- Must always convert cricothyroidotomy into tracheotomy eventually
Types of tracheostomy tubes
- Cuffed vs Non-cuffed
- Fenestrated vs Non-fenestrated
- Single lumen vs Double lumen
- Adjustable flange
Post-tracheostomy care
- Humidification
- Clearance of secretions/airway patency
- Tube care
- Wound care
- Cuff care
- Feeding and communication
- Tracheostomy tube is changed every 3 months
Complications of tracheostomy
Intra-op
GA-related risks
- Airway fire (High % of O2) - That’s why don’t use diethylene as can cause airway to catch fire
- Bleeding
- Injury to surrounding structures (RLN, carotid artery)
Post-op
Early
- Pneumothorax/ Pneumomediastinum/ Subcutaneous emphysema
- Secondary hemorrhage
- Infection
- Tube obstruction/ Accidental decannulation
Late
- Tracheal stenosis
- Tracheo-cutaneous fistula
- Tracheo-esophageal fistula
- Tracheo-innominate artery fistula
- Infection
Decannulation of tube
- Ensure original pathology requiring tracheostomy is resolved
- Nil ongoing respiratory infx, upper airway bleeding, need for ventilation
- Examine upper airway to ensure patency
- Ensure patient is on a non-cuffed, fenestrated tube to facilitate spigotting
- Spigot tube for progressively longer durations
- Fit for decannulation if patient can tolerate spigot >24h
- Remove tube
- Tape gauze over wound
**Don’t need to stitch up, let wound progressively close on its own
