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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
ORIGINAL ARTICLES CRITICAL AND INTENSIVE THERAPY
Minerva Anestesiologica 1998 September;64(9):393-7
Translaryngeal tracheostomy (TLT). A different technique for hypoxic and difficult to intubate patients
Sarpellon M., Marson F., Nani R., Chiarini L., Bradariolo S., Fonzari C.
Ospedale S. Maria dei Battuti - Treviso, I Servizio di Anestesia e Rianimazione
Aim. To prepare a variation to the original Fantoni technique for the purpose of performing a translaryngeal tracheostomy (TLT) without the need for repeated endotracheal intubation operations, neck movements and phases of apnea, in order to make this technique practicable and completely safe in the case of patients who are difficult to intubate, have cervical rachis injuries or suffer from serious hypoxemia.
Setting. Multi-purpose intensive care.
Patients. Fourteen patients (18-79 years old) to undergo tracheostomy, suffering from various limitations contraindicating the performance of a TLT according to the original Fantoni technique.
Operation. Distinctive elements of the illustrated technique are: 1) the use of a fiberbronchoscope in place of the rigid tracheoscope; 2) the insertion into the trachea of a particular guidewire, with J-shaped tip, placed on the outside of the artificial airway; 3) the use of a small-diameter endotracheal tube positioned coaxially to the original airway, to ventilate the patient during the introduction of the tracheostomy tube.
Results. TLT was performed on 13 patients. In one case it was not performed because of the impossibility of introducing the thin endotracheal tube in the original artificial airway. No problems, complications or SatO2 reductions occurred during operations.
Conclusions. The variation presented is a safe and easy-to-perform technique considered advantageous in the case of TLTs performed on patients suffering from serious hypoxemia, who are difficult to intubate or have cervical rachis injuries.