TRACHEOSTOMY ANAESTHESIA TUTORIAL OF ... - Anaesthesia UK

Sign up to receive ATOTW weekly - email worldanaesthesia@mac.comTECHNIQUES FOR INSERTIONTracheostomy may be performed using a percutaneous or an open surgical technique.Percutaneous tracheostomy is performed by anaesthesiologists or intensivists, usually under fibreopticbronchoscopic guidance. Open surgical tracheostomies are performed by ENT surgeons and in somecountries, trauma surgeons. Percutaneous tracheostomy was first described in the late 1950s and 1960sbut received widespread acceptance following introduction of commercial kits.Two initial techniques were described – a serial dilatational technique described by Ciaglia et al 6 in1985 and a guidewire dilating forceps (GWDF) method described by Griggs and colleagues in 1990. In2000, Byhahn et al modified the Ciaglia technique by introducing the Blue Rhino 7 (Figure 1). Thishydrophilically coated, curved dilator allows progressive dilatation of the tracheal stoma in a singlestep, reducing the risk of posterior tracheal wall injury, intraoperative bleeding and the adverse effecton oxygenation during repeated airway obstruction by sequential dilators.Figure 1. The Blue Rhino single stage dilator (Cook Medical).Percutaneous Tracheostomy InsertionMany commercial kits are available, all employing a Seldinger guidewire technique for tracheostomytube insertion. Techniques may vary slightly, depending upon operator preference and experience butthe basics principles of insertion are described below.ATOTW 241 – Tracheostomy 17/10/2011 Page 3 of 12