Transstomal flexible brochoscopy and replacement of the trach tube

[santoshpant99]

DESCRIPTION OF PROCEDURE:
The patient was therefore brought to the operating room. An appropriate time-out was
made. The patient was reidentified, surgery reiterated, the patient was then placed
under general anesthetic by the Department of Anesthesia. During the procedure, the
patient was orally intubated and the tracheal tube was removed leaving a bougie tube
within the lumen of the trachea. A flexible laryngoscope was then used to look in
and through the tracheal stoma at the trachea itself. The carina was visualized.
There was some irritation noted on the posterior wall of the trachea itself from the
previous tube. The tube itself seemed to be too small in length that it was easily moved around and therefore caused the irritation of her trachea tube. Her vocal
cords were visualized earlier with the Glidescope and there were no polyps noted on
the vocal cords. The patient was then gradually extubated. While she was being
extubated, the new Shiley 7.0 distally extended tube was placed into the lumen over
the bougie tube. There was no blood noted. The trach tube went in quite easily,
even though it was approximately 1.5 mm larger in diameter and then the cuff
inflated. Immediately she was getting better respiratory volumes. The trach tube
was secured in place. The inner cannula was placed in it and the patient got
appropriate ventilation. Prior to placing the tube, the patient was sterilely
prepped and draped. The patient was sent back to recovery room. At no time did her
oxygen saturations go below 90; in fact, most of the time they were approximately 98%
to 99% saturation. The patient is to continue her meds without any special
medications for this procedure.