17 - Tracheostomy

Summary

Introduction

Although some authorities have suggested that Egyptian stone tablets from around 3600 BC depict tracheostomy, this remains speculative; however, indirect evidence of sporadic attempts at tracheostomy are suggested by Coelius Aurelianus's comment, writing in the fifth century AD, that it was a ‘futile and irresponsible idea’. By the early seventeenth century, little had changed as Hieronymus Fabricius ab Aquapendente, an anatomist and surgeon in Padua, called the operation a ‘scandal’. Despite the use of tracheostomies by Marco Aurelio Severino to save a number of lives during the 1610 diphtheria epidemic in Naples, there were only 28 successful procedures recorded between 1500 and 1833. Towards the end of this period, Pierre Bretonneau published a description of diphtheria and reported the successful use of tracheostomy to relieve asphyxiation. By the 1850s, a survival rate of 27% was considered a success, and in Morrell Mackenzie's 1880 textbook on laryngology the issue of how a surgeon must determine ‘whether the symptoms are sufficiently urgent to render the operation necessary’ is addressed (Figure 17.1). Chevalier Jackson described the modern surgical tracheostomy in 1909, and until the introduction of positive pressure ventilation for respiratory failure as opposed to anaesthesia, tracheostomy remained a surgical procedure for bypassing glottic or supraglottic airway obstruction, or was required as a consequence of laryngectomy.