Preoperative Measures for Tracheotomy in Severe Pseudocroup

Abstract

During the one-year period from September 1960 through August 1961 a substantial rise in the incidence of severe pseudocroup was observed. Tracheotomy was required in 17 of the cases in this series. In our experience considerable value attaches to immediate administration of oxygen and air under positive pressure to assist the respiration and thus reduce the anoxia. Attention is drawn to the advisability of using intubation anesthesia for tracheotomy, with the aim of preoperatively raising the negative intrathoracic pressure, thereby lessening the danger of mediastinal emphysema and pneumothorax.

As regards pulmonary ventilation and initial anesthesia in epiglottitis, emphasis is placed on the importance of measures designed to widen the entrance to the larynx and to prevent a backward and downward displacement of the epiglottis.

In cases with supraglottic edema a slender, relatively firm tube is technically the simplest and best suited for intubation.

In subglottic edema, on the other hand, it is advisable to employ the largest tube that will pass the glottis. By careful manipulation the tube can be guided past the subglottic edema, which presents little resistance. Such a tube will then facilitate the removal of mucus and crusts from the trachea, a procedure that is difficult or impossible when slender tubes are employed.