Aaron's Operation

Aaron's Operative Note

The patient had an approximately 2 cm horizontal incision made through the
subcutaneous tissues with a 15 blade approximately 1 finger breadth above the
sternal notch. Using a Bovie pointed tip on coag and cutting, hemostasis was
obtained and the dissection was carried down to the level of the visceral
fascia. The strap muscles were separated using blunt dissection and the
trachea was identified. We did not come upon the thyroid gland during the
dissection or the innominate artery. After identifying the trachea, blunt
dissection was used to palpate up the trachea to the level of the cricoid
cartilage. After this was identified, two stay sutures were placed
approximately at the level of the third tracheal ring, one was placed on the
left and one was placed on the right, these were 4-0 silks, using the C.O.
cutting needle. These were both secured on each side and at that point an
approximately 0.5 cm vertical incision was made in the trachea using the 15
blade. During this time, traction was maintained on both stay sutures as well
as on a tracheal hook that was placed at the superior aspect of the vertical
incision in the trachea. The endotracheal tube was gradually backed out and
during the period in which the patient's oxygen level was maintained in 99
percentile in terms of saturation, a 00 neonatal tracheostomy tube was placed.
The ET tube was removed and the tracheostomy tube was repositioned and hooked
up to the ventilator. Anesthesia and ventilation was continued to be provided
by the Anesthesiology Team. The patient remained stable during this process.
Next, two 4-0 prolene simple sutures were placed on each side of the
horizontal superficial incision to narrow the incision some. There was one on
the left and one on the right and the stay sutures were brought out medial to
these. The stay sutures were then taped to the patients chest, one on the
right and one on the left that were labeled both right and left accordingly.
At that point, his small approximately 1 inch strip of Iodoform 1/4 inch gauze
was then placed immediately inferior to the tracheostomy flange, inside the
wound to serve as packing. This is to be removed in approximately 24 hours.
Trach ties were then secured around the patient's neck with the patients
cervical spine in a partially flexed position. The operation at that point
being finished, the patient was then transferred to the Anesthesiology Team
after it was clear that the tracheostomy tube had been tightly secured to his
neck. Both stay sutures as previously mentioned were tapped to the patient's
thorax, one on the right and one on the left and were labeled accordingly. The
patient was then transferred to the Pediatric Intensive Care Unit with a
postoperative chest x-ray ordered and care to be provided by the pediatric
intensive care unit team.