The patient was brought to the OR and placed under general anesthetic. The neck was prepped and draped. 1 percent lidocaine with epinephrine was injected into the neck. A 3-cm incision was

Pre and post-operative diagnoses: Respiratory Failure Operation: …
Pre and post-operative diagnoses: Respiratory Failure
Operation: Tracheostomy
Indication: This is a female with respiratory failure, and multiple attempts to wean from the vent have failed. The family was explained the risks and benefits of a tracheostomy and consent was obtained.
Procedure: The patient was brought to the OR and placed under general anesthetic. The neck was prepped and draped. 1 percent lidocaine with epinephrine was injected into the neck. A 3-cm incision was made two fingerbreadths above the sternal notch. A large amount of subcutaneous fat was dissected with a Bovie cautery. The strap muscles were identified and divided in the midline, exposing a large thyroid isthmus. The thyroid isthmus was divided exposing the trachea. An incision was made between the second and third tracheal ring and an inferior based tracheal flap was created. The inferior flap was sewn to the inferior skin edge, creating a skin flap in order to mature the stoma with 3-0 Vicryl. The ET tube was slowly withdrawn to just above the tracheostomy site. An 8.0 XLT trach tube was placed in the patient with no difficulties. The trach was hooked up to the anesthesia circuit and secured to the skin with 2-0 silk. The patient remained stable throughout this procedure.
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