Name of the Procedure:

Tracheostomy, planned (separate procedure); younger than 2 years

Summary

A tracheostomy is a surgical procedure where an opening is made in the neck to place a tube into a child's windpipe (trachea). This helps provide a direct airway for breathing when normal breathing is disrupted.

Purpose

This procedure is performed to address severe respiratory issues in children who are younger than 2 years old. It helps to ensure adequate airflow to the lungs when other methods of keeping the airway open have failed or are not suitable. The goals are to improve breathing, facilitate the removal of airway secretions, and reduce the reliance on mechanical ventilation.

Indications

• Severe airway obstruction due to congenital abnormalities (e.g., laryngeal atresia, subglottic stenosis)
• Chronic respiratory failure requiring prolonged ventilatory support
• Neuromuscular disorders affecting respiratory function
• Severe facial or airway trauma

Preparation

• Parents/guardians will be instructed to ensure the child fasts 6-8 hours before the procedure to minimize the risk of aspiration.
• Routine pre-operative blood work and assessments will be conducted.
• Pre-operative imaging studies like X-rays or bronchoscopy may be performed to plan the procedure.

Procedure Description

1. The child will be placed under general anesthesia to ensure they are completely asleep and pain-free.
2. A small horizontal or vertical incision is made in the front of the neck, just below the Adam's apple.
3. Through careful dissection, the trachea is exposed, and an opening is created.
4. A tracheostomy tube is inserted into this opening, secured in place, and connected to a breathing machine if necessary.
5. The incision is then closed around the tube, and an appropriate dressing is applied.

Duration

The procedure typically takes about 30 to 60 minutes to complete.

Setting

The procedure is performed in a hospital setting, specifically in an operating room.

Personnel

• Pediatric surgeon or otolaryngologist (ENT specialist)
• Anesthesiologist
• Surgical nurse
• Pediatric respiratory therapist

Risks and Complications

Common risks:

• Infection at the surgery site
• Bleeding
• Dislodgement or obstruction of the tracheostomy tube

Rare risks:

• Tracheal damage
• Impaired vocal cord function
• Long-term airway issues

Benefits

• Immediate relief of airway obstruction, allowing the child to breathe more easily.
• Improved oxygenation and ventilation.
• Reduced risk of hospitalization due to recurrent respiratory problems.

Recovery

• Post-procedure, the child will typically stay in the intensive care unit (ICU) for close monitoring.
• Parents/guardians will be educated on how to care for the tracheostomy at home.
• Follow-up appointments with the surgeon and pediatrician.
• Full recovery time varies but children can usually return to regular activities within a few weeks.

Alternatives

• Non-invasive ventilation (e.g., CPAP or BiPAP)
• Endotracheal intubation for temporary airway management
• Each alternative has its own set of pros and cons, such as varying degrees of comfort, potential for infection, and practicality over long-term use.

Patient Experience

During the procedure, the child will not feel any pain due to general anesthesia. Post-operatively, there may be some discomfort or soreness at the incision site, which will be managed with appropriate pain relief measures. Parents should expect some initial adjustments to life with a tracheostomy, including learning tube care and monitoring the child for any signs of complications.