ABSTRACT
This chapter discusses the indications for a tracheostomy, methods of tracheostomy insertion and the complications of a tracheostomy. A transverse skin incision is made along a skin crease midway between the cricoid cartilage and the suprasternal notch. The pretracheal muscles are separated, and the thyroid isthmus is divided between clamps and its raw edges oversewn. The tracheostomy is performed between the second and fourth tracheal rings, either excising a 1-cm window of the trachea or creating an inferiorly based flap. The tracheal tube is inserted and secured with sutures to the peri-stomal skin. Haemorrhage from the thyroid isthmus, damage to the trachea and damage to surrounding structures – recurrent laryngeal nerve, oesophagus are the immediate complications of a tracheostomy. Subcutaneous emphysema, mediastinal emphysema and pneumothorax, obstruction of the tube or the trachea by secretions, infection, dislodgement of the tube, which may be partial or complete, and pneumonia are early complications of a tracheostomy.
