By P. Puri, M.E. Höllwarth
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Additional info for Pediatric Surgery (Springer Surgery Atlas Series)
Lobe 26 CONCLUSION 4 Tracheostomy is a simple technical procedure to perform, but it can be one of the more difficult procedures in paediatrics. The cannula should be selected carefully to make certain that it is not too long after the roll (used to extend the neck) is removed and the patient is repositioned. Occasionally, it is necessary to order a special tracheostomy cannula. Such is the case for a short, wide trachea. The most common problems occur post-operatively when the cannula becomes occluded or, worse yet, dislodged.
Postnatal presentation is characterized by drooling of saliva and cyanotic attacks. If passage of 12 F feeding tube into the stomach is not possible, oesophageal atresia is almost certain. Immediate oro- or naso-oesophageal insertion of a Replogle tube as soon as the diagnosis is established is mandatory for continuous or intermittent aspiration of saliva in order to prevent aspiration. The baby should be nursed propped up in order to prevent aspiration of gastric contents in to the tracheobronchial tree.
The neck should be extended sufficiently to allow complete access to the neck. Sometimes, on chubby infants, it is still difficult to see the entire neck, despite the best attempts. A roll should be placed under the infant’s shoulders to facilitate proper positioning. The endotracheal tube should be secured so that the anaesthesiologist can easily remove the tube at the appropriate time. This means that any tape should be loosened before hand. If there is a feeding tube in place, it should be removed so that it does not interfere with endotracheal tube manipulation.