tracheostomy An opening in the trachea (stoma: Greek for ‘mouth’). The operation which creates the opening is tracheotomy (tome: Greek for ‘incision’); it involves slitting open the trachea (windpipe), to enable the patient to breathe when the upper respiratory tract is obstructed either by a foreign body or as a result of disease or injury.

It is an operation with an ancient history, reportedly first thought of by Asculaepius in 100 bc when he was, according to Galen, trying to devise a way of relieving patients suffering from ‘those species of quinsies in which there is great danger of suffocation’. There is evidence that the operation was used occasionally in antiquity, and with increasing frequency from the Renaissance. In this simple form, however, it afforded the patient only brief relief, since the artificial opening rapidly closed itself. It was only with the invention of the cannula — a hollow tube which permits the draining of fluids — around 1600, that more extended opening could be practised. The invention of the double cannula in the late eighteenth century was an important improvement: it allowed for the tube to be cleared and cleaned without inconveniencing the patient.

Despite these improvements, tracheostomy was only rarely performed before the mid nineteenth century, most notably in attempts to revive the hanged. It then achieved greater — and increasing — prominence as more virulent strains of diphtheria emerged in Western Europe in the 1850s. Diphtheria is an acute infectious disease characterized by the development of a membrane across the back of the throat, which may threaten suffocation, although death is usually due to the effects of the toxin released into the patient's system by the infecting organism. Diphtheria was first identified as a specific disease by Pierre Bretonneau in 1824, and it was his pupil, Armand Trousseau, who established tracheostomy as a treatment option through his work at the Paris Childrens' Hospital in the 1830s and 1840s.

With the spread of the virulent form of diphtheria after 1855, doctors across Europe became increasingly familiar with the operation, and its technique was gradually refined. It was the only operation which, it was said, every practising doctor had to be prepared to perform. By the turn of the century, however, American hospital practitioners had begun to use intubation (passing a tube into the trachea via the mouth) in preference to tracheostomy, and this development gradually influenced European practice. Despite the introduction of anti-toxin therapy in the 1890s, diphtheria remained a public health problem in the twentieth century until the development and application of active immunization in the interwar period, and for as long as the disease was present, tracheostomy remained a treatment option, notably in Britain, where it continued to be the intervention of choice for threatened obstruction. By 1950, however, diphtheria had all but vanished as a public health problem in the West.

Meanwhile tracheostomy was beginning to be applied not to relieve obstruction to the airway, but to assist the use of artificial ventilation, for example in cases of paralytic poliomyelitis, head injuries, chest injuries, and barbiturate poisoning.

Tracheostomy remains a routine procedure in intensive therapy units when prolonged connection to an artificial ventilator is required. In other instances, permanent tracheostomy allows a person to breathe for himself after operation for cancer of the larynx.

Anne Hardy

tracheostomy (tracheotomy) (tray-ki-ost-ŏmi) n. a surgical operation in which a hole is made into the trachea through the neck to relieve obstruction to breathing, as in diphtheria. A curved metal, plastic, or rubber tube is usually inserted through the hole and held in position by tapes tied round the neck. See also minitracheostomy.
www.nhsdirect.nhs.uk/articles/article.aspx?articleId=371 Explanation of tracheostomy from NHS Direct Online