Considerations during Perioperative Tracheostoma Management

Dear Editor, Tracheostoma management is a norm, not an exception, perioperatively especially in tertiary care centres.[1-4] Therefore, considerations are warranted to safely and securely manage tracheostoma perioperatively. Herein, some of such considerations are being shared, which are open to adaptation by readers exploring them in their own practices at their own healthcare institutions, as guided or limited by the resources of healthcare personnel and/or healthcare equipment. The very first question is whether perioperative tracheostoma management is elective or emergent. If elective, the very next question is whether perioperative personnel and equipment are ready for safe and secure management of the elective procedure in the patient having a tracheostoma. Assuming that there is no choice (in emergent procedure) or a choice made (in elective procedure), the next few things to consider are (a) whether the patient is an obligate neck breather with no airway access to trachea via mouth–nose; (b) whether the patient can safely undergo bag-mask ventilation with neonatal/infant size 0/1 anaesthesia face mask or laryngeal mask airway (or any other supraglottic airway) providing airtight seal over tracheostoma if bag-mask ventilation infeasible via mouth–nose with or without oropharyngeal-nasopharyngeal airway adjuncts[5] and (c) whether the institution has extracorporeal membrane oxygenation capabilities electively/emergently if warranted and so on and so forth to name a few as adaptable to any perioperative practice at any healthcare institution. Thereafter, if procedure’s/patient’s time-sensitive clinical scenario allows, the very next few things to consider are whether the perioperative area has access to equipment for (a) continuous waveform capnography, (b) video laryngoscopy and (c) fibreoptic bronchoscopy (reusable or disposable; non-detachable or detachable[6,7]), besides the availability for (a) airway exchange catheters, (b) suction catheters, (c) smallest size microlaryngeal tubes (cuffed or uncuffed[8]) and (d) thinnest-longest flexible cuffed/uncuffed tracheostomy tubes with obturators/introducers.[9] All these considerations are because false passages around tracheostoma are not uncommon and can be catastrophic if not recognised in emergent or even elective clinical scenarios, especially when speaking valve could be confusing regarding whether a non-obligate facultative neck breathing patient is inhaling via tracheostoma or via mouth–nose.[10,11] Simplistically, above-mentioned considerations may form some sort of adaptable backbone to online available and adaptable algorithms for keeping perioperative tracheostoma management safe and secure.[12-14] All these considerations are for preventing patients/providers/places from becoming first/second/third victims, respectively, when tracheostoma is in the play perioperatively. Authors’ contributions DG contributed to concept, manuscript preparation, manuscript editing and manuscript review; MI contributed to concept, manuscript editing and manuscript review. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.