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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 through the 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 a problem with the upper airway that causes difficulty breathing and inadequate oxygen delivery. Severe facial or neck trauma, foreign objects stuck in the back of the throat, throat cancer or collapsing trachea are the most often reasons to perform a tracheostomy. The procedure may be permanent or temporary, an emergency measure or elective.

Causes of obstructions include laryngeal paralysis; laryngeal edema; elongated soft palate; pharyngeal polyps; foreign body obstructions; and upper airway swelling, wounds or lacerations.

A tracheostomy tube may also be inserted following upper airway surgery, in which postoperative swelling may narrow the airway. A tracheostomy also allows 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. Insertion of a tracheostomy tube also allows the passage of air or oxygen into the lungs, as indicated for disorders such as acute respiratory distress syndrome, smoke inhalation and carbon monoxide poisoning.

What Preoperative Examinations or Tests Are Needed?

Preoperative tests depend in part on the age and general health of the animal as well as the cause for the tracheostomy. If the tracheostomy is performed in an emergency situation when the pet is in danger of dying due to the inability to breath, no preoperative tests are done. If the tracheostomy is associated with major trauma, cancer or tracheal problems, extensive tests such as radiographs, blood count, serum biochemical tests, a urinalysis, and possibly an EKG may be necessary.

What Type of Anesthesia is Needed For a Tracheostomy?

In an emergency situation, the tracheostomy may be performed without anesthesia or ultrashort anesthetic may be used. In non-emergency situations, the procedure requires general anesthesia to induce complete unconsciousness and relaxation. In the usual case, the pet will receive a pre-anesthetic sedative-analgesic drug to help him relax, a brief intravenous anesthetic to allow placement of a breathing tube in the windpipe (if possible), and subsequently inhalation (gas) anesthesia and oxygen during 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, which lies in the area of the neck. 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 a more permanent situation, the edges of the new tracheal opening are sutured to the skin to create a permanent opening. Some surgeons choose to use absorbable sutures (stitches) that dissolve over time. Other surgeons use non-absorbable sutures that need to be removed in about 10 to 14 days. The procedure allows your pet to breathe in and out of the tracheostomy site and not through the nose or mouth.

Temporary tracheostomies are typically performed in association with foreign objects in the mouth or severe laryngeal swelling. Once the underlying cause of the breathing difficulty is removed, the temporary breathing tube is removed and the incision is allowed to heal.

How Long Does the Tracheostomy Take to Perform?

The procedure takes about 15 to 45 minutes to perform, depending on whether it is an emergency situation or a more permanent procedure. In some cases, the procedure can take longer and may require two surgeons or referral to 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 the tracheostomy is usually difficulty breathing, and when an animal cannot breathe, his life is at risk. The major risks are those of general anesthesia, inability to breath, bleeding (hemorrhage), postoperative incision infection and pneumonia. Future scar formation closing off the trachea in a permanent tracheostomy is another concern. Overall complication rate is low, but serious complications 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 judged in most cases to be mild to moderate and can be effectively eliminated with safe and effective pain medicines. The home care requires reduced activity until the stitches are removed in 10 to 14 days and preventing the pet from scratching or rubbing at the surgery site. Daily cleaning of the surgery site will be necessary until it has healed. In the case of temporary tracheostomies, your pet is sent home without the breathing tube but with an opening in the neck that will scar and close over time. The pet is still able to breathe normally through the nose and mouth. Monitoring the incision for redness and swelling is important. The pet needs to be able to breath normally. Any signs of difficulty breathing or excessive coughing should prompt you to contact your veterinarian.

How Long Is the Hospital Stay Following a Tracheostomy?

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

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