Tracheostomy

All patients will have ETT
Mild neck extension
Towel under shoulders, Head ring
LA infiltration
Prep and drape
Collar incision 1-2 finger breadths above sternal notch
Incise platysma
Separate strap muscles (sternohyoid and sternothyroid) in midline
Keep dissection exactly in midline to avoid bleeding
Divide isthmus with diathermy to expose second and third tracheal rings
Horizontal incision between rings with cricoid hook in place (Stomal size is directly related to tracheal stenosis, avoid 1st ring as risk of subglottic stenosis)
Withdraw ETT
Place suitably sized ETT (size 6-10: inner tube 6-10mm for adults) after cuff tested and lubricated
Suture cuff in place
Close skin with nylon
Tracheosotmy tape around neck

Complications
Haemorrhage (up to 40%) (3% pts have thyroidea ima artery)
Tracheoinnominate fistula if tube too low in trachea
Tracheal stenosis