Details of Procedure:
The patient was correctly identified, brought to the operating room, and transferred to the operating table. General anesthesia was administered. The patient was positioned with a shoulder roll in neck extension. Her neck was prepped and draped in a sterile fashion. I began with a transverse incision 2 finger breadths above the sternal notch, just below the cricoid cartilage. The incision was carried down through subcutaneous tissue and platysma. The dissection then continued through the mid-line between the strap muscles. The thyroid gland was visualized and the pre-tracheal fascia was incised to reveal the trachea. Hemostasis was obtained at this point.
A point on the trachea between the 2nd/3rd tracheal rings was identified for tracheostomy and this was marked with cautery. In conjunction with anesthesia, the ETT cuff was desuflated and advanced into the trachea. I then entered the trachea with a #15 blade, making a inferiorly based trap-door incision. A 3-0 PDS was passed through the sternal skin and the trap door to aid with opening. Anesthesia then pulled the ETT back and I inserted a cuffed Shiley #8 tracheostomy tube after trach spreader dilation. The anesthesia circuit was connected to the tracheostomy and end tidal co2 confirmed.  The trache was secured to the skin with 2-0 nylon suture. Betadyne soaked gauze was used as dressing below the tracheostomy.