The patient was brought into the operating room and identified by name and medical record number. General endotracheal anesthesia was successfully induced by the anesthesia service.  The patient was placed in the supine position and a shoulder roll was placed.  The patient was then prepped and draped in the standard fashion for tracheostomy.  A center horizontal tracheostomy incision was marked midway between the cricoid cartilage and the sternal notch.  The incision site was anesthetized using a total of (amount) ccs of lidocaine with epinephrine (1:100,000 mixture).

The incision was then made using a 10 blade, and blunt dissection and cautery were used to dissect through the soft tissue of the strap muscles.  The midline was identified, and the strap muscles were retracted laterally.  (anything done with thyroid?).  Draining veins were identified and cauterized with bipolar cautery.  Paramedian tissues were gently retracted laterally; the trachea was cleaned and easily visualized.  An incision was made in the trachea between the (second & third?) tracheal rings and extended inferiorly by 1 ring using heavy scissors.  A Bjork flap was raised and sutured to the subdermal tissue.

The endotracheal tube was removed, and a (size and type of tube) tracheostomy tube was placed without difficulty.  The cuff was inflated, the circuit was reconnected, and CO2 confirmation was obtained.  The tracheostomy device was then secured in place with 0-silk sutures at each of the four quadrants.  The patient tolerated the procedure well with oxygen saturation never falling below 90%.  A soft tracheostomy collar was then placed around the neck and a split tracheostomy gauze was placed around the tracheostomy tube.  The procedure was then terminated and the patient was turned over to the anesthesia team for recovery.  There was minimal blood loss and no complications.  All surgical pauses were observed.  Standard operating room protocol and universal precautions were utilized throughout the procedure.