DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Traumatic fall.
2. Ventilator dependent.
POSTOPERATIVE DIAGNOSES:
1. Traumatic fall.
2. Ventilator dependent.
OPERATION PERFORMED: Percutaneous tracheostomy with bronchoscopy assist.
SURGEON: John Doe, MD
ANESTHESIA: Intravenous at the bedside, consisting of propofol, Versed, and vecuronium.
ESTIMATED BLOOD LOSS: Less than 10 mL.
COMPLICATIONS: There were no complications during the percutaneous tracheostomy with bronchoscopy assist.
DESCRIPTION OF OPERATION: The percutaneous tracheostomy with bronchoscopy assist was done in the intensive care unit at the bedside with intravenous anesthesia. Propofol and Versed was given to sedate the patient. The patient was then positioned in the manner for maximum exposure of the anterior portion of the neck. The neck was then prepped and draped in the usual sterile fashion with chlorhexidine. Local anesthesia consisting of 1% lidocaine with epinephrine was injected into the subcutaneous tissue at approximate position of the initial skin incision. Approximately 3 mL of lidocaine was given.
The patient’s anterior neck was then palpated for the cricoid cartilage and the tracheal rings just below it. A small vertical incision was made measuring approximately 2 cm through the skin and into the subcutaneous tissue. Minimal bleeding was noted during this step. Careful dissection was done using a hemostat to avoid the lateral blood vessels. Dissection was done all the way through the subcutaneous tissue to the tracheal fascia. The tracheal rings were then carefully palpated to determine the exact position, which is approximately between tracheal ring numbers two and three and that the tracheostomy would be inserted at the exact midline position as well.
Upon palpation of the second and third ring, the Angiocath was inserted. Angiocath was introduced easily with good drawback of air. The bronchoscopy was used to visualize the entry of the Angiocath. The needle and syringe were then removed with the Angiocath in place. A guidewire was then threaded into the tracheal airway. Serial dilation was done using the dilator. After complete dilation was performed, the tracheostomy tube was then passed over the wire. A #8 Shiley tracheostomy tube was then placed into the airway. The tracheostomy slid easily into the airway without any difficulty.
The guidewire was then removed. Bronchoscopy was again used to visualize the placement of the tracheostomy tube. There was minimal bleeding noted in the airway at this time. The ventilator circuit was then connected to the tracheostomy. The bronchoscope was used for the last time to assess for tracheostomy tube placement. The tracheostomy cuff was then inflated. The tracheostomy tube was then sutured at the skin in four quadrants with a 2-0 silk suture. The tracheostomy tube was then further secured into place with a neck band.
At this time, the ventilator was noted to be oxygenating the patient well with saturations well above 95%. Throughout this procedure, the patient did not have any desaturations. There was also minimal blood loss noted throughout the procedure. The patient tolerated the procedure well without any complications. A chest x-ray was ordered to be taken after completion of a triple lumen central venous catheter in the left subclavian vein.
