2. Respiration is interfered with during introduction, so that celerity is indispensable, accidents are frequent, and failure is common.
3. Tube may be coughed up (28%, Goodall[39]), blocked (12%, Goodall), and does not provide good drainage for secretions.
4. Swallowing difficult.
5. Complications common: Broncho-pneumonia, ulceration, cicatrization.
6. After-treatment difficult and constant watching required.
7. Necessity for secondary tracheotomy (32.6%), which has a greater mortality (death in 46.1%, see table below).
8. Retained tube.
In considering the above it is the obvious duty of the surgeon to advise what he considers the better operation for the case, and this must depend largely upon the amount of his experience; the argument that the operation is superior because it can be previously practised on the cadaver is a bad one, and implies a failure to realize the many difficulties which will be encountered in the selection of cases, the operation itself, and its after-management.
I am strongly of opinion that the operation ought not to be tried indiscriminately by those who have no knowledge of these difficulties. In the hands of an expert it is a justifiable method of treatment which is suitable for selected cases, and it is one which can be used early; tracheotomy, on the other hand, is naturally delayed, or used for serious cases and those which have not derived relief from intubation.
Although intubation has received extensive trial, the published results show great variations and do not prove that intubation is superior to tracheotomy, but rather the reverse.