A tracheostomy is a long-term or permanent surgical procedure where a hole is made into the trachea (windpipe). It is sometimes used for severe obstructive sleep apnea or when there is a narrowing in the airway (tracheal stenosis). It can be performed under local or general anesthesia. The surgery normally lasts around 45 minutes and is relatively safe.

    When you are about to have a tracheostomy, you will have some "pre-op" tests done. Usually, you will have an H&H (a blood test that measures hemoglobin and hematocrit), EKG (a non-invasive test that checks the electrical activity from your heart), and a chest x-ray done. Depending on your age and physical health, you may have a few other tests done. An overnight sleep study may also be done.

    On the night before your surgery, you should not eat or drink anything within 8 hours of your surgery. You should allocate 10 hours just in case if you end up in surgery earlier than expected. You may have water as late as 7 hours before the surgery. While hospitals routinely tell you eat or drink nothing after midnight of the night before your surgery, this is unreasonable if your surgery is much later than noon that day. However, just be careful with your calculations!

    After signing into the hospital, you will be taken to an area where you will be prepared for the surgery. Here, you will remove your clothes, jewelry, and other removable items and then put on a hospital gown. You will also have your vital signs checked and be asked some medical questions. You will then be placed on a stretcher ready to be wheeled into surgery.

    After being wheeled to the surgical area, you may be placed into a holding area or be taken directly to an OR (operating room). Here, an IV line will be started in your arm. This will be used for hydration and possibly sedation and/or general anesthesia. Since this is not a major surgery, only a medium sized or small IV needle will be used.

    Once you are in the OR (operating room), an IV will be started if not already done so. You will also be connected to various monitors which are noninvasive. This will include EKG wires, blood pressure cuff, and a pulse oximeter sensor on a finger. A safety strap will be placed over your thighs or waist. Since the operating tables are often narrow, a sheet may be wrapped around your chest and arms for support of your arms. You may also be given some oxygen to breathe.

    You may be sedated for the surgery. If this is the case, you will feel woozy during surgery, and this is to help calm your nerves. This may also cause minor burning or irritation where the IV needle is.

    If you are to receive general anesthesia (be put to sleep), you will be given a drug through your IV line and/or a gas to breathe. While some adults can handle the surgery under just local anesthesia, children and some adults may need to be put to sleep, for the surgery may be too traumatic.

    If you are receiving local anesthesia, Lidocaine is likely to be used. While you may just barely feel the needle, Lidocaine will sting when injected. Those with a low pain tolerance may be unable withstand the stinging. HOWEVER, this stinging will go away in about a minute or so. You will NOT be given Lidocaine if you are put to sleep.

    If you are not being put to sleep and the lights bother you, please speak up. Someone in the OR may put something over your eyes.

    If you are put to sleep, you will wake up in a recovery room. You MAY still be connected to a ventilator, but this will be removed most likely within an hour after you regain consciousness. Also while you are in the recovery room, you will feel the blood pressure cuff tighten up on your arm every once in a while. Your vision may also be very blurry for about 1-3 hours. If you are an older patient and/or don’t have a good respiratory system, you may be asked to do some breathing exercises while in the recovery room.

    You will feel a doctor or two pressing on your throat a bit. Rest assured that they will NOT strangle you, although you may get a somewhat strangled feeling. The purpose of this is so that the surgeon can be certain that he or she is about to cut into the trachea. You will also feel a pen tip on your throat area. Here, the doctor is marking the area to be cut into. Reference marks may also be made.

    Around this time, a somewhat soft wedge will be placed under your upper back. This will be a little uncomfortable, but not too bad. This is to hyperextend your neck without any effort on your part. The reason why your neck needs to be hyperextended is so that the trachea will be easier to work on.

    You will also see a doctor or nurse prep your chest area with a brown and smelly substance. This is called betadine. It is a skin aseptic that is more effective than alcohol. Please note that the smell will pretty much go away in a few minutes. However, the smell may cause you to cough for a few minutes, and this is normal, particularly if you are not used to it.

    Next, you will be draped for the procedure. Sterile drapes will be placed over your shoulders and chest area.

    After you are numbed and draped, the actual surgery will begin. If the area was numbed well enough, you should feel NO pain surgery the surgery. HOWEVER, you will feel some pressure every once in a while, but this should not be unbearable.

    In some parts of the surgery, you will be able to speak to the staff in the OR. At other times, you will have to hold very still so that the surgeon can do his job easier.

    About two-thirds or three-fourths of the way through the surgery, the trachea (windpipe) will be exposed. You will be given a tracheal anesthetic. While you will probably just barely feel the needle, you will have a coughing spell that will probably last about 2-3 seconds. This is normal. You will most likely be given two doses of this. However, a small amount of time will be given between injections in order for you to get back to your senses and be less likely to be overwhelmed. You can rest easy knowing that numbing the trachea is MUCH easier to handle pain-wise than numbing the skin area in front of it. The pain is not NEAR as bad as with the Lidocaine injections.

   After the trachea is “fenestrated” (meaning that a hole is put into it), the hole will be suctioned out to help prevent debris from getting down into your trachea.  You will get a sensation as if your breath is being taken away.  However, this will last only a few seconds, and your chest muscles will probably be strong enough to keep things from getting too bad.  The cannula will then be inserted.  Again, you will feel some pressure, but this should not be unbearable.

    After the cannula is inserted and the suturing is completed, you will be asked to test out the cannula by speaking. It will feel funny at first and you will run out of "steam" very quickly. You may be lucky to get more than 2-3 syllables or words out in one breath. This is perfectly normal. Next, you will be given a chance to feel the front of your cannula and learn how to occlude it with your finger so that you can talk and cough. You will not have the cannula capped for 1-4 days so that the stoma (hole made into your neck) will HOPEFULLY start to heal properly.

    Before you are taken out of the operating room, the monitors will be removed from you. Also your chest, neck, and chin area will be cleaned off.

    Since you were not put sleep, you may not even be taken to a recovery room. If you do end up in there, it will be Easy Street for you, for they will be getting a regular room ready!

    You may have some pain the first few hours or even days after the surgery. If it is bothersome, let the nurses know, and you may be given some pain medicine. If a Montgomery cannula was used, nurses may want to study you a bit after being taken to your room.

    You are free to talk all you want and feel like, but you may have some soreness the first day or so. You may also have some difficulty swallowing, but this should be minor and short-lived (just a few days).

    During your hospital stay, a nurse will periodically clean crusts and drainage from around the stoma (the hole in your neck). This procedure MAY actually feel kind of good.

    Unless you have a health problem or something that prohibits you from eating a regular diet, you will be free to devour anything you want!

    About 1-2 days after the surgery, a doctor or assistant may install a ring onto the cannula if it is a Montgomery cannula. This ring will hold your cork so you don’t lose it. Again, you will feel pressure on the front of your neck momentarily when he or she puts this in place.

    Before you are released from the hospital, you will be given instructions on how to care for your cannula and such.

    Be SURE to hold onto your discharge paper(s) just in case if you have questions to ask the nurse(s) after you are home.

    As for physical activity, you probably should not do heavy physical activity for about a week or so. However, you will probably feel like cooking meals and doing minor housework, and this is fine.

    You may have a slight fever and somewhat elevated pulse rate for a few days. This is normal. This is due to the natural trauma of the surgery and the fact that you may have a slight transient infection which will most likely go away on its own in a few days. HOWEVER, if your fever is significant and/or your heart is just racing, be sure to call the nurse(s) and/or doctor.

    While you should not keep the cannula plugged for about 1-4 days, you will need to use the plug if you are going out into cold and/or rainy weather or if you are going to take a shower. HOWEVER, be SURE to remove the plug immediately after you are in a suitable environment.

    Below are some pictures of what you expect to look like.