ABSTRACT
As a surgical procedure, the patient is usually already intubated and anaesthetized and he is positioned supine with his neck extended, often with a sandbag under the shoulders (Figure 7.6a). In principle, the operation proceeds as shown diagrammatically in Figure 7.12. Immediately before incising the trachea, oxygenate the patient on 100% O2 and be sure that the equipment is present to intubate the patient orally again if necessary. Once the trachea is incised (sometimes the ET tube cuff is punctured), or just before it is incised, let down the cuff and pull the ET tube back (but try to keep the tip below the cords) and allow the surgeon to insert the tracheostomy tube. After a successful insertion, inflate the tracheostomy tube cuff and connect the ventilator tubing to the tracheostomy tube. Make sure that the lungs ventilate properly, particularly checking that the tip of the tracheostomy tube is not down the right main bronchus.
