Minitracheostomy

IS TRACHEOSTOMY OBSOLETE?

Standard Tracheostomy is the method routinely used to relieve upper airway obstruction. This method though effective has its attendant complications. Minitracheostomy, which is a small cannula of 4 mm diameter introduced through the cricothyroid membrane has been tried in our series to relieve inspiratory stridor and also to deliver anaesthesia. The arterial oxygen saturation increased very significantly from 81.66% to 97.67%. The cannula was well accepted by the patients and there were very few complications.

A serious complication of minitracheotomy

A previously unreported complication of minitracheotomy is described. The minitracheotomy introducer was lost into the pleural cavity and a thoracotomy was required to remove it.

Minitracheostomy in elective surgery of the larynx: an alternative to formal tracheostomy

A patient scheduled for surgical removal of a giant polyp of the larynx, and in whom difficult orotracheal intubation was anticipated in the preoperative visit, was managed successfully with a minitracheostomy performed with a Mini-Trach II kit. The ventilation achieved was adequate throughout the procedure. Thus, conventional tracheostomy was avoided.

Minitracheotomy Seldinger--assessment of a new technique

A multicentre, prospective study of 26 patients was undertaken for the assessment of insertion of minitracheotomy tubes by the Seldinger technique. The technique of insertion is described. There were two misplacements, three blockages of the inserting Tuohy needle with fat, and six cases of difficulty in passing the minitracheotomy tube.

Intraoesophageal placement of minitracheotomy tube

A minitracheotomy tube was inadvertently placed in the oesophagus of a 22-year-old woman with cystic fibrosis. The authors discuss how this may have occurred and ways of avoiding this complication.

Minitracheotomy--a life-threatening complication

A 55-year-old patient developed profuse haemorrhage immediately after insertion of a minitracheotomy tube. Measured blood loss was 1.1 litres, and the bleeding required to be controlled surgically. The cause was a subglottic granuloma which had developed after prolonged tracheal intubation and which was incised during insertion of the minitracheotomy.

Pneumothorax caused by minitracheotomy

We describe a case in which misplacement of a minitracheotomy tube produced a pneumothorax, a complication which has not been reported previously. Methods to identify correct placement of the minitracheotomy tube are discussed.

Ventilation and ventilators--an update

In the five years which have passed since the previous review, the literature has been concerned more with the ways in which ventilators may be applied to patients and the effects of differing patterns of ventilation than with the design philosophy of the ventilators themselves. This account should be read in conjunction with that of 1982 [1].