Stéphanie M.P. Noël DVM, PhD, Dipl. ECVS
Temporary tracheostomy relieves life-threatening upper airway obstruction. The most common indications are laryngeal masses, trauma, upper airway swelling1,2,3,4,5,6 and dynamic upper airway obstruction secondary to severe feline asthma.7 Perioperative temporary tracheostomy can be considered for tracheal,8 temporomandibular,9 or arytenoid surgery.10
Contraindications are the presence of a mass, obstruction, or collapse distal to the tracheostomy site or previous tracheal stent placement.11,12
The diameter of the tube should not exceed 75% of the tracheal diameter to allow airflow around the tube when obstructed.11 In cats, single lumen non-cuffed pediatric plastic tracheostomy tubes from 3- to 5-mm are typically used.3,8,10 If commercial tubes are not available, an endotracheal tube serves as an alternative.8,11,12
If possible, general anesthesia and intubation secures the airway and allows for oxygenation and ventilation. In emergency scenarios, slash tracheostomy,13 percutaneous tracheostomy14,15 and needle cricothyroidotomy12 have been described. An emergency tracheostomy pack readily in the emergency area should include tracheostomy tubes of different sizes, sterile surgical instruments, suture material, and umbilical tape. Different techniques, such as transverse tracheostomy, tracheal flap, or vertical incision, have been described.11 We’ll present the transverse tracheostomy, the easiest technique, in which the incision width may not exceed half of the tracheal circumference (video 94.1).
3. Procedure outline
As a tracheostomy bypasses the upper respiratory airways, cold dry air is delivered to the trachea, inducing increased mucus production. Permanent monitoring and intensive care are mandatory. Regular care is required at least every 4 to 6 hours. It consists of preoxygenation, humidification with sterile isotonic saline solution or nebulization, and sterile aspiration if required. Due to the small trachea of cats, tubes lack a removable inner cannula to facilitate cleaning. Therefore, the tracheostomy tube must be changed daily. After tube removal, the surgical site heals by second intention.11
3. Procedure outline
Major complications are reported in 44% of cats with temporary tracheostomies, including tube occlusion by excessive mucus production and tube dislodgement. Minor complications are reported in 74%, including partial obstruction, fever, pneumomediastinum, subcutaneous emphysema, edema, Horner’s syndrome, laryngeal paralysis, cough, vomiting, and dislodgement of stay sutures.1
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14. Silverman BS, Robello G, Fowell E. Percutaneous tracheostomy in the dog. Mod Vet Pract 63:62-63, 1982.
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Video 94.1 Temporary tracheostomy technique