Elective tracheostomy in infants and children

Abstract

Elective tracheostomy in children may be performed with safety if the surgeon is thoroughly acquainted with the anatomy of the region and the occasional anomalous situation. Practically all tracheostomy tubes in use today for children and infants are excessive in length. These unanatomical tubes should be revised for use in children between the ages of the newborn to twelve years, and in no instance should they be longer than 5.5 cm. The 90 degree tube, although unsatisfactory in some instances, still possesses the best arc. The tracheostomy tube should be of a smaller diameter than the trachea. Serious consideration must be given to the performance of an elective tracheostomy in the following situations: (1) when there has been a difficult endotracheal intubation; (2) in surgery about the pharynx, larynx, tongue or mandible, when permanent or temporary respiratory obstruction may be a consequence; (3) in prolonged comatose states; and (4) in trauma to the respiratory tract or lungs, such as in a burn, when efficient respiratory toilet is essential. Proper equipment set up conveniently in trays and including Y-tubes and marked catheters must be on hand at all times. It is only by such continued and diligent attention to detail, as has been described, that the tragedies so frequently associated with this procedure may be averted.