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What is a Tracheostomy?

By: PetPlace Veterinarians

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A tracheostomy is a surgical procedure that creates an opening into the trachea through the neck. The opening is maintained by insertion of a tracheostomy tube. This tube, commonly referred to as a "trach tube", bypasses the upper airway to allow your pet to breath easier.

What Are the Indications for Performing a Tracheostomy?

Tracheostomy is indicated whenever there is an upper airway obstruction that prevents adequate respiration (breathing) and gas exchange.

Indications to perform a tracheostomy include severe upper airway swelling and facial or neck trauma, wounds or lacerations, foreign bodies lodged in the back of the throat, throat cancer, and pharyngeal polyps Tracheostomy can be permanent or temporary. It can be an emergency measure or an elective procedure. A tracheostomy tube is sometimes inserted following upper airway surgery following which postoperative swelling may cause narrowing of the airway.

Functionally, insertion of a tracheostomy tube maintains a patent airway and allows air or oxygen to be delivered to the lungs in conditions such as acute respiratory distress syndrome, smoke inhalation, and carbon monoxide poisoning. A tracheostomy also permits continuous or intermittent access to the lower airway for removal of secretions. This can be important when treating smoke inhalation, aspiration pneumonia, and other forms of pneumonia.

What Preoperative Examinations or Tests Are Needed?

Which preoperative tests, if any, are indicated depends on the age and general health of the animal as well as the reason for the tracheostomy. If the tracheostomy is performed in an emergency situation, when the pet is in danger of dying as a result of a respiratory obstruction, no preoperative tests should be performed at all. If the tracheostomy is elective, perhaps associated with pharyngeal cancer or tracheal problems, tests such as radiographs, blood count, serum biochemical tests, urinalysis, and possibly an EKG may be indicated.         

What Type of Anesthesia is Needed For a Tracheostomy?

In an emergency situation, the tracheostomy may be performed without anesthesia or under the influence of an ultrashort-acting injectable anesthetic agent. In non-emergency situations, the procedure is usually performed under general anesthesia to facilitate unconsciousness, immobility, and complete relaxation. Usually, the pet is given a pre-anesthetic sedative-analgesic drug to help him relax, a short-acting intravenous anesthetic to allow placement of a breathing tube in the windpipe (if possible), and subsequently inhalation anesthesia for the actual surgery.

How Is the Tracheostomy Done?

The pet is placed on a surgical table, lying on his back. The hair on the underside (ventral) of the neck is clipped and the skin is scrubbed with surgical soap to disinfect the area. A sterile drape is placed over the surgical site. A scalpel is used to incise the skin of the neck being careful to avoid the thyroid gland. Dissection of surrounding tissues and muscles is necessary to isolate the trachea. Once the trachea is exposed, a section of one tracheal ring is removed, creating an opening into the windpipe (trachea). The tracheostomy tube is inserted through the incision in the trachea and either tied in place with umbilical tape or sutured to the skin of the neck. For more permanent maintenance of the tracheostomy, the edges of the new tracheal opening may be sutured to the skin to create a permanent aperture. Some surgeons choose to use absorbable sutures (stitches) that disappear in time. Other surgeons use non-absorbable sutures that need to be removed after about 10 to 14 days. The procedure allows your pet to breathe in and out of the tracheostomy opening, instead of the nose and mouth.

Temporary tracheostomies are typically performed in association with foreign bodies in the mouth or severe laryngeal swelling. Once the underlying cause of the respiratory obstruction is resolved, the tracheostomy tube is removed and the incision is allowed to heal.

How Long Does the Tracheostomy Take to Perform?

Tracheotomy takes about 15 to 45 minutes to perform, depending on whether it is a temporary emergency procedure or requires more permanent positioning. In some cases, the procedure be complicated, potentially taking much longer, and may require a board certified surgeon.

What Are the Risks and Complications of a Tracheostomy Operation?

The overall risk of this surgery is moderate. The reason for tracheostomy is usually difficulty in breathing, and when an animal cannot breathe, his life is at risk. The major risks are of the procedure are those of general anesthesia, bleeding (hemorrhage), postoperative infection of the incision, and pneumonia. Future scar formation closing off the trachea in a permanent tracheostomy is another concern. The overall complication rate is low, but serious crises can result in death, or the need for additional surgery.

What Is the Typical Postoperative Care?

Postoperative medication should be given to relieve pain, which is mild to moderate in most cases and can be effectively controlled with safe and effective pain medicines. Home care requires keeping the pet quiet until the stitches are removed 10 to 14 days later, and preventing the pet from scratching or rubbing at the surgery site. Daily cleaning of the tracheostomy site is necessary until the edges of the opening have healed. Following temporary tracheostomy, your pet may be sent home without the breathing tube in place but with an opening in its neck that will scar and close over time. The pet should still be able to breathe normally through its nose and mouth. Monitoring the incision for redness and swelling is important. The pet should also be able to breathe easily and without signs of obstruction (snoring, gasping). Any signs of difficulty breathing, or excessive coughing, should prompt you to contact your veterinarian immediately.

How Long Is the Hospital Stay Following a Tracheostomy?

The typical hospital stay following tracheostomy is two to three days, but will vary depending on the overall health of your pet, the underlying reason for the procedure, and your pet's ability to breathe normally following surgery.

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