Nihon Kikan Shokudoka Gakkai Kaiho
Online ISSN : 1880-6848
Print ISSN : 0029-0645
ISSN-L : 0029-0645
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Volume 58, Issue 5
Displaying 1-15 of 15 articles from this issue
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Special Issue of The Present Status of Tracheostomy — From the Standpoint of a Specialist
  • Tracheostomy
    Hiroya Kitano
    2007 Volume 58 Issue 5 Pages 433-439
    Published: 2007
    Released on J-STAGE: October 25, 2007
    DOIhttps://doi.org/10.2468/jbes.58.433
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    Indications for tracheostomy are as follows : 1. to avoid dyspnea caused by upper respiratory obstruction (tumor, foreign body, injury, etc.) ;2. to remove secretions from the distal tracheobronchial tree;3. to instill oxygen into the lungs in cases of difficult intubation. Tracheostomies divide into two groups according to the degree of urgency and emergency or elective operation. In cases when the operation is not an emergency, surgical procedures should be performed under safe and well-equipped conditions. The most important point relating to surgical technique for emergency tracheostomies is how to perform the tracheostomy immediately and safely. For this purpose, the best way is to make a vertical incision and to identify the cricoid cartilage as soon as possible. Elective tracheostomy is performed under general or local anesthesia. The advantages of a transverse incision are cosmetic results and easy management after surgery. The most important point with a tracheostomy for anaplastic thyroid cancer is to avoid hemorrhage from the thyroid isthmus.
    Tracheostomy is a basic technique for surgeons, yet in some cases this technique is dangerous. Therefore, surgeons should have a thorough understanding of the anatomy of this region as well as surgical technique.
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  • Tracheostomy in Children
    Fumiyo Kudou
    2007 Volume 58 Issue 5 Pages 440-447
    Published: 2007
    Released on J-STAGE: October 25, 2007
    DOIhttps://doi.org/10.2468/jbes.58.440
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    The number of tracheostomies performed in children has increased, particularly in infants, in tandem with the development of neonatal-perinatal medicine. The prevalence in pediatric tracheotomies is toward younger aged patients. However, there is a significant difference between tracheostomies performed in adults and those in children. Pediatric tracheostomies should be performed with full awareness of that difference.
    Statistics on tracheostomies in children show that the great majority (40 to 67%) of pediatric tracheostomies are performed during the first year of life.
    There are two major indications for a tracheostomy in a pediatric patient: 1) upper airway obstruction and 2) assisted ventilation and tracheal toilet. Upper airway obstruction can be caused chiefly by congenital disorders such as anomaly of the larynx or dysfunction of the bilateral vocal cords.
    It is preferable to perform a tracheostomy in children under general anesthesia, using an endotracheal tube. With the patient positioned with the neck extended, a horizontal skin incision is made. When the operation is performed on children under six years of age, the tracheal incision is made at the level of the second to third tracheal rings and requires an incision through one to two tracheal rings. When performed on children older than seven years, the incision is made at the level of the isthmus of the thyroid glands.
    Retention sutures are placed through the tracheal wall on either side of the designed tracheal wall incision line, to aid in making the tracheal incision. After a vertical tracheal incision has been performed, the retention sutures still have to be kept less tight to see trachea much better. The endotracheal tube is slowly removed, during which a tracheostomy cannula is inserted. The endotracheal tube is completely removed after the tracheostomy cannula has been inserted. The retention sutures are secured to the skin of the chest by tape.
    The first tracheostomy cannula is changed around postoperative day number seven to ten, when the retention sutures can also be removed. Parental teaching is indispensable to take enough care of the tracheostomy at home.
    Much attention must be given to complications. Severely retarded children are more likely than others to suffer tracheo-innominate artery fistula (TIF) as a late complication.
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  • Tracheostomy in Respiratory Disease
    Tomohiro Hattori, Toru Majima
    2007 Volume 58 Issue 5 Pages 448-453
    Published: 2007
    Released on J-STAGE: October 25, 2007
    DOIhttps://doi.org/10.2468/jbes.58.448
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    When it is necessary to perform airway management in a patient with exacerbated respiratory disease, the first choice is endotracheal intubation. However, when mechanical ventilation is prolonged, it is considered more practical to perform a tracheostomy after assessing the risks and benefits of ventilation via endotracheal intubation or via a tracheostomy tube and the pathological features of the respiratory disease. With regard to timing of the switch from endotracheal intubation to tracheostomy, it is considered desirable to perform the tracheostomy within 10 days if the patient cannot become independent of mechanical ventilation by 7 days after endotracheal intubation. The tracheostomy tube is removed when the patient no longer needs mechanical ventilation, no upper airway obstruction is observed, the amount of secretions has decreased, and peak cough expiratory flow is adequate. In actual practice, the tube is removed after accurately assessing each patient's respiratory status.
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  • Percutaneous Dilatational Tracheostomy and Needle Cricothyrotomy
    Daisuke Yamaguchi, Naoki Yahagi
    2007 Volume 58 Issue 5 Pages 454-462
    Published: 2007
    Released on J-STAGE: October 25, 2007
    DOIhttps://doi.org/10.2468/jbes.58.454
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    Percutaneous dilatational tracheostomy (PDT) is an alternative method to traditional surgical open tracheostomy (SOT). As various PDT methods have been developed, PDT may be superior to SOT with respect to less frequent perioperative complications such as bleeding, wound infection and overall mortality. PDT also requires less procedure time and less experience to perform than SOT.
    Needle cricothyrotomy is a last resort to provide oxygenation and ventilation for difficult airway management (DAM) in patients who cannot be intubated and ventilated.
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  • Complications of Tracheotomies
    Hideki Hirabayashi
    2007 Volume 58 Issue 5 Pages 463-471
    Published: 2007
    Released on J-STAGE: October 25, 2007
    DOIhttps://doi.org/10.2468/jbes.58.463
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    Tracheotomy is essential part of modern medical care as airway management. However, inappropriate management of tracheotomies and tracheal tube can lead to various complications. The complications of tracheotomy will be reviewed in the immediate or early postoperative period, or after a longer time following the procedure. Specifically, this paper reports a case of successful management of innominate artery fistula.
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Original
  • Investigation of Percutaneous Tracheostomy and Surgical Tracheostomy
    Takashi Hirano, Naoki Uemura, Tetsuo Watanabe, Masashi Suzuki
    2007 Volume 58 Issue 5 Pages 472-477
    Published: 2007
    Released on J-STAGE: October 25, 2007
    DOIhttps://doi.org/10.2468/jbes.58.472
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    Since percutaneous tracheostomy (PT) was first introduced by Ciaglia, many investigations in the fields of intensive care or anesthesiology have reported safety and complication rates that are lower than or similar to those of surgical tracheostomy. However, it has also been reported by otolaryngologists that PT is associated with a higher prevalence of perioperative severe complications. In this study, we, as otolaryngologists, employed PT in four patients with acute inflammatory diseases and upper-airway edema, and reviewed their clinical records in comparison to those of PT compared with surgical tracheostomy. PT required only a small skin incision and minimal blunt dissection of the anterior tracheal structure, and it took only 5-7 min to perform this approach without serious complications in our four cases. We therefore conclude that PT is one useful approach for upper-airway obstruction in addition to standard surgical tracheostomy.
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  • Clinical Study of Tracheostomy and Minitracheotomy at Our Hospital
    Satsuki Yasumura, Masatsugu Asai, Miyuki Kobayashi, Hideo Shojaku, Hir ...
    2007 Volume 58 Issue 5 Pages 478-483
    Published: 2007
    Released on J-STAGE: October 25, 2007
    DOIhttps://doi.org/10.2468/jbes.58.478
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    We reviewed 72 cases that underwent surgical tracheostomy (ST) and 42 cases that underwent minitracheotomy at our hospital during 2005. At discharge, many cases had a stoma or puncture hole. The stomas indicated a little Retina® control. Short-term complications of ST occurred in 23.6% of the cases, and long-term complications in 15.3%. Short-term complications of minitracheotomy occurred in 9.5%, and long-term complications in 23.8%. There were no very serious complications in evidence during this study period. Although the frequency of major complications reported in the literature remains limited, there have been reports of severe complications, and it is necessary to consider such exceptional cases when requesting informed consent.
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Case Report
  • Subglottic Stenosis after Percutaneous Cricothyroidotomy
    Daisuke Mizokami, Takehiro Karaho, Susumu Isoda, Tetsuya Tanabe, Akihi ...
    2007 Volume 58 Issue 5 Pages 484-490
    Published: 2007
    Released on J-STAGE: October 25, 2007
    DOIhttps://doi.org/10.2468/jbes.58.484
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    Percutaneous dilational tracheostomy (PDT) has gained popularity among critical care specialists in the past 10 years. As a new technique, PDT is often used for the patients after cardiac surgery to prevent mediastinal infection caused by tracheostoma. Some studies suggest potential advantages of PDT relative to surgical tracheostomy, including ease of performance, and lower incidence of peristomal bleeding and postoperative infection. With PDT, the trachea is normally punctured between the first and second tracheal cartilages or in the subcricoid level. Although some surgeons perform PDT in the cricothyroid membrane in order to isolate the tracheostoma from a median sternotomy wound, to date there are no safety standards for percutaneous cricothyroidotomy. Here, we report two cases of subglottic stenosis caused by percutaneous cricothyroidotomy using Ciaglia Blue Rhino® (CBR;Cook Critical Medical Care, USA). The CBR involves one-step dilation by means of a curved dilator with hydrophilic coating. These two cases suggest that PDT in the cricothyroid membrane can lead to subglottic stenosis.
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  • A Case of T-cell Lymphoma Presenting as Obstructive Sleep Apnea Caused by Mediastinitis from Operative Acute Respiratory Failure
    Teruhiro Ogawa, Kikuko Naka, Ryousuke Matsumoto, Kazunori Tanimoto, Ta ...
    2007 Volume 58 Issue 5 Pages 491-497
    Published: 2007
    Released on J-STAGE: October 25, 2007
    DOIhttps://doi.org/10.2468/jbes.58.491
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    Obstructive sleep apnea syndrome (OSAS) often poses challenges to anesthesiologists. Gomez-Merino reported a case of T-cell lymphoma that began with symptoms of OSAS.
    We encountered a case of solitary extranodal lymphoma in the palatine tonsils masked by SAS, which consequently caused unanticipated difficulty in intubation during surgery for SAS, i.e., palatine tonsillectomy.
    A 51-year-old male presented to a local ENT doctor with continuing discomfort in the throat after upper respiratory tract infection is reported. He also had difficulty in swallowing solid food. It was suspected that the patient had OSAS, and he was referred to our clinic.
    The patient showed markedly hypertrophic bilateral palatine tonsils (Mackenzie's grade III) and notable lingual tonsil swelling. ENT fiberscope only showed the posterior margin of the vocal cords and the arytenoids region. Because no other abnormalities were noted, uvulopalatinopharyngoplasty (UPPP) under general anesthesia was planned. During the operation, full attempt was made to visualize the airway, which revealed papillary neoplastic proliferation extending from the tongue base to the larynx, with the epiglottis atrophied and the trachea and vocal cords indistinguishable. It was difficult to perform endoscopic intubation, and a tracheostomy was required. Subsequent biopsy of the tonsils showed no further abnormality, and the UPPP was performed on a later date. The patient was histopathologically diagnosed with peripheral T-cell lymphoma, unspecified.
    Because mediastinal emphysema with aspiration pneumonia and cervical esophageal minimal perforation developed as complications, elective operation was canceled and the patient was kept in ICU for two weeks, during which time drainage tubes were inserted at the superior mediastinum for two weeks.
    We discuss a rare case of intubation difficulty due to T-cell lymphoma that presented as OSAS, with consideration of relevant literature.
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  • Clinical Study of Tracheostomy Cases Received after Three-field Lymph Node Dissection for Esophageal Cancer
    Masanobu Taniguchi, Akihito Watanabe, Hitoshi Tsujie, Masao Hosokawa
    2007 Volume 58 Issue 5 Pages 498-501
    Published: 2007
    Released on J-STAGE: October 25, 2007
    DOIhttps://doi.org/10.2468/jbes.58.498
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    Sixteen cases who had received tracheostomy after three-field lymph node dissection for esophageal cancer at Keiyukai Sapporo Hospital between January 2000 and February 2007 were reviewed. The anterior neck skin was sutured to the strap muscle in order that the operative field of the esophageal cancer was completely separated from salivary contamination from the tracheostomy orifice. None of the cases suffered from wound infection or anastomotic leak after the tracheostomy.
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  • Complications in Changing the Tracheostomy Tube after Percutaneous Dilational Tracheostomy
    Eri Maeda, Miwako Kimura, Takaharu Nito, Shingo Takano, Niro Tayama
    2007 Volume 58 Issue 5 Pages 502-506
    Published: 2007
    Released on J-STAGE: October 25, 2007
    DOIhttps://doi.org/10.2468/jbes.58.502
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    Endoscopic percutaneous dilational tracheostomy (PDT) has come to be used widely in intensive care units. PDT is simple to perform and is reported to be as safe as surgical tracheostomy, but changing of the tracheostomy tube after PDT may be difficult. Here, we report a case whose tracheostomy tube was misplaced in the anterior mediastinum during a tube change after PDT. This case demonstrates the potential danger of changing the tube in the post-operative period. The surgical method and PDT are shown to differ with regard to the dimensions of the tracheostomy orifice and the passage from the orifice to the trachea. Additionally, we propose solutions for tube misplacement after PDT.
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