The oldest recorded surgical procedure on the airway is in the Edwin Smith Papyrus, an ancient Egyptian medical text thought to date to around 1600 BC, which

demonstrates a procedure thought to be a tracheostomy to provide an emergency airway in trauma [1]. It is impossible to know exactly when the rst tracheostomy was attempted, but there is evidence from hieroglyph slabs belonging to King Djer in Abydos and King Aha in Saqqara that tracheostomy was performed in ancient Egypt in about 3100 BC.Hippocrates, in 400 BC, condemned the procedure, men­tioning the risks of carotid artery lesions. In AD131, Galeno described the larynx and tracheal anatomy and identied the site of laryngeal voice generation and lar­ynx innervation. In the fourth century BC, Alexander the Great is said to have saved the life of a soldier who was choking from a bone lodged in his throat by “punctur­ing his trachea” with the point of his sword [2].

Many authors of this period described tracheostomy in detail, but none of them claimed to have performed it themselves. References were made to tracheostomy, but the operation was considered both useless and dangerous due to the high risk of wound infection and a belief that cartilage rings could not heal.

In the early 1600s, tracheostomy was considered acceptable for acute upper airway obstruction caused by foreign body ingestion, aspiration, and infection [7]. In Fig.2 we can see an illustration of the procedure from that period. Renaus Moreau suggested its use in mumps, recommending that the procedure be performed with the patient in the supine position, a recommendation that was ignored for nearly 200years [8].

When George Washington (the rst president of the USA) presented with airway obstruction secondary to a peritonsillar abscess, Dr. Elisha Dick suggested a

In 1730, the British surgeon George Martin introduced the double-lumen can­nula with the advantage of an inner cannula that could be removed and cleaned, thus preventing tube obstruction with mucus. There is no record of whether he used it [11].