At XYZ Hospital, we perform at least a half a dozen tracheostomies every week. Done largely for VDRF (ventilatory-dependent respiratory failure) - these surgeries are performed on patients who are unable to be weaned from a ventilator, or are facing longterm ventilation management for their condition. The longer an endotracheal tube sits in a person’s trachea, the greater the chances of acquiring an infection, and/or complications like tracheo-esophogeal fistula and tracheal malacia. Thus necessitating the need for the tracheostomy.

Many of the patients we see for this type of surgery need a tracheostomy as a temporizing measure - they may have an upper airway situation that needs time to be corrected. So many others get “trach-ed” for long-term management of their ventilatory needs. Too often these are patients who may be victims of massive stroke or other brain events, severe respiratory compromise or distress, or hemodynamic instability requiring longterm ventilatory management.

So many of our tracheostomy patients are unable to speak (or think or write) for themselves. They may be comatose, vegetative, or even too young to consent for themselves. The decision to be trach-ed in these cases has been designated to loved ones and family members.

Tracheostomies provide a lifeline of hope to many who need the airway support and vital access to breathe and maintain a clear airway. Trachs also provide an indefinite extension of existence to those who are now victims of our advanced technologies.

Anesthesia for these procedures can be done with local anesthesia and sedation (these are often done at the bedside in many hospitals) but at XYZ Hospital, we do all non-emergent tracheostomies in the OR under general anesthesia. As these patients are already intubated, we connect the patient to the monitors and the ventilator and our anesthesia agents. The surgeons can begin their work, and we supplement the anesthetic throughout the case with any necessary muscle relaxant and narcotic requirements. In an uneventful case, the procedure takes about 15 minutes.

At the end of the tracheostomy procedure, the patient has a stoma and a plastic airway just above the sterno-clavicular notch, and may then proceed with the next phase of their medical journey.