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SUR 111
Tracheotomy/Tracheostomy
Appendectomy
Tracheotomy
Tracheostomy
Tracheotomy/Tracheostomy
• Tracheotomy temporary opening into the trachea
to facilitate breathing
• Tracheostomy permanent opening of the trachea
and creation of a tracheal stoma
• Must place tracheal tube with either
• Patient will be hooked up to a ventilator
• Long term tracheostomy may eventually be able to
wean off ventilator, but maintain stoma that will
function as their nose did prior to surgery
• Tracheostomy is indicated for a patient
who requires emergent or elective airway
management for:
– prolonged ventilator dependence
– acute upper airway obstruction
– chronic upper airway obstruction
Pathology for Tracheotomy or
Tracheostomy
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Vocal cord paralysis
Neck surgery
Trauma
Prolonged intubation
Secretion management
Cannot intubate
Stridor due to tracheal blockage
Sleep apnea
Anatomy of the Neck
(From Potter PA and Perry AG: Fundamentals
of nursing, ed 5, St Louis, 2001, Mosby.)
Anatomy of the Larynx
Anterior view
of the pharynx
Posterior view
of the pharynx
(From Thibodeau GA and Patton KT: Anthony's textbook of anatomy and
physiology, ed 17, St Louis, 2003, Mosby.)
Anesthesia
• General
• Local
Medications
• Local anesthetic: Lidocaine or bupivicaine
with or without epinephrine
• Antibiotic irrigation
Positioning
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Supine
Shoulder roll
Donut headrest
Pillow under knees
Safety strap
Prep
• End of chin to midchest and bedsheet to
bedsheet
• Prep of choice: Duraprep, betadine scrub
and/or paint
Draping
• Towels
• Small fenestrated sheet (Pediatric lap sheet)
Supplies, Equipment, Instruments
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Minor basin
Basic pack
Pediatric lap sheet
Other small fenestrated
sheet
• Blades
• Suture or ties of surgeon’s
choice (prn)
• Tracheotomy tray
• Tracheotomy tube
(Shiley)
• Twill tape
Surgical Procedures
• Tracheotomy/Tracheostomy
Isthmus of thyroid is
divided to expose
the trachea
Two tracheal rings are cut,
and the upper ring is
partially resected. Tracheal
hook pulls the trachea
from the depth of the
wound toward the surface
Tube is inserted
(Modified from DeWeese DD: Textbook of otolaryngology, ed 6, St Louis, 1982, Mosby.)
Operative Sequence
• Discussion
• http://video.google.com/videoplay?docid=261546049131841443&q=tr
acheostomy&total=37&start=0&num=10&so=0&type=search&plinde
x=0
Considerations
• Will make sure obturator goes with patient
to PACU or ICU
• Complications: hemorrhage, infection,
damage to other structures
Large Intestine (Colon) Anatomy
Look to page 395-404 in ST
• Appendectomy
– Removal of the appendix
• Appendicitis
– Inflammation/infection of the appendix
– Acute condition
– Urgent procedure
• Becomes emergent procedure if ruptures
– Rupture leads to peritonitis which untreated leads to death
• Sometimes Removed as Prophylactic Procedure
(Incidental Appendectomy) in addition to other lower
abdominal surgical procedures
• Laparoscopic Appendectomy
The base of the mesoappendix is
coagulated using the endocoagulator
(From Goldberg JM and Falcone T: Atlas of endoscopic
techniques in gynecology, Philadelphia, 2001, Saunders.)
• The appendix is attached to the
mesoappendix, which is divided with
scissors or ESU and ligated with vessel
clips or surgical stapler
• Laparoscopic Appendectomy,
continued
The endo-loop is tightened at the base of the appendix
(From Goldberg JM and Falcone T: Atlas of endoscopic
techniques in gynecology, Philadelphia, 2001, Saunders.)
• Once the appendix is mobilized, it can be
amputated from the cecum
• Two ties must be placed around the
appendix between the lines of amputation
• Laparoscopic Appendectomy,
continued
The appendix is excised with scissors
(From Goldberg JM and Falcone T: Atlas of endoscopic
techniques in gynecology, Philadelphia, 2001, Saunders.)
• The appendix is then transected with the
ESU, scissors, or surgical stapler
• The stapler provides additional security
against leakage
• The specimen is brought out of the
abdomen with a specimen retrieval bag
• Loop technique:
http://www.dailymotion.com/video/x403wh
_lap-appendectomy_tech
• Stapler technique:
http://www.dailymotion.com/video/x4046e
_lap-appendectomy-with-stapler_tech