[Translarnygeal tracheostomy (TLT). A variant technique for use in hypoxemic conditions and in the difficult airway]. / Tracheostomia translaringea (TLT). Variante tecnica per l'utilizzo in condizioni di ipossiemia e di difficile controllo delle vie aeree.

AIM: To prepare a variation to the original Fantoni technique for the purpose of performing a translaryngeal tracheostomy (TLT) without the need for repeated endotracheal intubation operations, neck movements and phases of apnea, in order to make this technique practicable and completely safe in the case of patients who are difficult to intubate, have cervical rachis injuries or suffer from serious hypoxemia. SETTING: Multi-purpose intensive care. PATIENTS: Fourteen patients (18-79 years old) to undergo tracheostomy, suffering from various limitations contraindicating the performance of a TLT according to the original Fantoni technique. OPERATION: Distinctive elements of the illustrated technique are: 1) the use of a fiber-bronchoscope in place of the rigid tracheoscope; 2) the insertion into the trachea of a particular guidewire, with J-shaped tip, placed on the outside of the artificial airway; 3) the use of a small-diameter endotracheal tube positioned coaxially to the original airway, to ventilate the patient during the introduction of the tracheostomy tube. RESULTS: TLT was performed on 13 patients. In one case it was not performed because of the impossibility of introducing the thin endotracheal tube in the original artificial airway. No problems, complications or SatO2 reductions occurred during operations. CONCLUSIONS: The variation presented is a safe and easy-to-perform technique considered advantageous in the case of TLTs performed on patients suffering from serious hypoxemia, who are difficult to intubate or have cervical rachis injuries.

[The Fantoni translaryngeal tracheostomy: perioperative complications In a series of 220 consecutive patients]. / Tracheotomia translaringea secondo Fantoni. Complicanze perioperatorie su una serie consecutiva di 220 pazienti.

BACKGROUND: To evaluate problems arisen du-ring Fantoni translaryngeal tracheostomy (TLT). SETTING: intensive care unit. PATIENTS: 220 patients (aged from 18 to 87). EXCLUSION CRITERIA: coagulopathy, difficult intubation, local infections, previous neck surgery, suspected cervical spine lesion, severe hypoxemia, hemodynamic instability, patients close to be discharged from ICU. Operation: TLT was performed in general anesthesia, using the technique described by Fantoni in 206 cases; in the other 14 cases changes were made. RESULTS: Perioperative clinical complications were separated from instrumental problems. Clinical complications were 28 (12.7% of TLT): 20 (9.1% of total TLT, 71.4% of total complications) were considered minor and ascribed to medical staff training; among these the complete drawing of the cannula and the difficulty in pushing it in trachea. Eight complications (3.6% of TLT, 28.6% of total complications) were considered major; they were: the impossibility to place the cannula in trachea, the displacement of the prothesis in the peritracheal tissue, the rupture of tracheal ring, the bleeding and the infection of tracheostomy, the dental uprooting. Among instrumental problems, the faulty closure of the ring nut, the overdimension of rigid tracheoscope, and the difficult change of the cannula were observed. CONCLUSIONS: With expert medical staff, this technique is effective and safe, with a low rate of complications. Major complications were rare, and occurred in spite of patients selection, often needing changing of TLT in surgical tracheostomy.