Awake tracheotomy is a method that can be used to preserve spontaneous breathing while under local anesthetic. Typical indications include stenotic tumors of the larynx and hypopharynx. 6.7% of patients report cough as a problem due to the tube.
Patients who are considered candidates for an awake tracheotomy should have a well-trained team available, including a anesthesiologist experienced in airway management, a surgeon skilled in tracheal surgery, a critical care nurse experienced in managing patients undergoing this procedure, and a respiratory therapist knowledgeable about mechanical ventilation settings appropriate for this patient population.
The patient is given general anesthesia, during which time a small incision is made in the neck below the collarbone. The trachea is exposed by lifting up the skin and lining of the chest cavity. The trachea is then separated from its cartilage rings. This allows the surgeon to see and work on the airway without obstruction from the jaw or tongue. The vocal cords next to the opening in the trachea are usually removed (laryngoscopy is performed to verify correct position). After removal of the vocal cords, the opening in the trachea is closed using several layers of sutures.
Cricothyroidotomy is used to provide an airway during an emergency since tracheostomy takes longer and is more difficult to do. A tracheostomy is a surgical technique that creates a hole (stoma) in the front of the neck that leads to the windpipe (trachea). The stoma can be closed when the crisis has been resolved or left open if further intervention is needed.
In contrast, a tracheostomy is a surgical procedure that creates a hole (stoma) in the front of the neck that leads to the windpipe (trachea). A tracheostomy does not lead to immediate relief from air hunger because it does not allow for direct connection of the lungs to the outside world. Instead, it provides a permanent connection using a tube placed through the skin into the chest cavity. A tracheostomy can be done as a treatment for individuals who will continue to require respiratory support long after their injury has healed. It is also used as a precaution while they are being treated in an intensive care unit since its presence allows for continued oxygenation even if they go into cardiac arrest.
Tracheostomies usually but not always involve the placement of a metal rod inside the trachea through the stoma. This makes it possible for doctors to keep track of the patient's airway by visual inspection.
When general anesthesia is administered, intubation is necessary. The anesthetic medications immobilize the muscles of the body, including the diaphragm, making it hard to breathe without the assistance of a ventilator. The majority of patients are extubated, which means that the breathing tube is withdrawn soon after surgery. However, some require mechanical ventilation after surgery.
Intubation allows for the administration of other medications through the breathing tube, such as antibiotics for those at risk for developing pneumonia. It also allows for rapid increase in air pressure if the patient begins to exhale air into the stomach instead of the lungs (this occurs when there is trauma to the throat or neck area). This can be corrected by placing another tube down the esophagus and into the stomach.
The person performing the intubation must have adequate training and experience with this procedure. Anesthesiologists who work in hospitals with many surgeries each day are most likely to know how to do this safely. Otherwise, others who are not familiar with this type of work should not attempt it.
As with any invasive procedure, there is a risk of infection when inserting a breathing tube. The virus that causes the common cold may enter through tiny breaks in the skin caused by surgery or needles. There is also a chance that you could pass on your own bacteria to someone else.
Tracheal stenosis is most usually induced by inflammation and scarring after intubation, insertion of a breathing tube into the trachea after surgery, or when mechanical ventilation is required (respirator). The small airways between the large branches of the trachea are particularly prone to injury during intubation. Inflammatory diseases such as tuberculosis and sarcoidosis may cause tracheal stenosis as well.
The symptoms of tracheal stenosis include cough, wheezing, shortness of breath, chest pain, and stridor (the sound of air rushing through the narrowed airway). A patient with tracheal stenosis may also have fever, chills, night sweats, and weight loss. If left untreated, tracheal stenosis can lead to severe respiratory problems and even death.
Treatment for tracheal stenosis depends on the cause. If the disease is due to inflammation or trauma, then medications used to treat these conditions will help too. For example, patients with tracheal stenosis caused by tuberculosis may be treated with antibiotics and steroids. Patients who suffer from tracheal stenosis due to chronic use of cigarettes may require long-term oxygen therapy or tracheal resection/split thickness skin grafts.
General anesthesia frequently necessitates the need to be intubated and placed on a ventilator, which implies that most operations will necessitate this sort of treatment. While it is frightening to think about being on a ventilator, most surgical patients are breathing on their own within minutes of the procedure's completion. In fact, more than 90 percent of patients can be weaned off of the ventilator before midnight after a single operation.
The patient's lungs require oxygen to function properly. Under normal circumstances, blood flows through arteries into smaller veins, passing oxygen to all parts of the body and taking away carbon dioxide for elimination. However, when you are under general anesthesia, this flow of blood is prevented or slowed down so that you do not feel any pain while you are operating on. Since lungs depend on blood flow to deliver oxygen to them and remove waste products from them, they would experience ischemia (lack of blood) if anesthetized without ventilation.
However, since patients normally breathe themselves during surgery, there is no reason why they could not breathe under anesthesia. Before becoming an anesthesiologist, Dr. Gupta spent several years as a surgeon who often performed many surgeries in one day. He said that he has never heard of anyone dying because they could not breathe under anesthesia.
That does not mean that it cannot happen.