Successful Conservative Management of Tracheal Injury After
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Abstract
A-56-year-old woman underwent carpal tunnel release surgery under general anesthesia. Thirty minutes after extubation, the patient complained of chest discomfort with dyspnea. Swelling of the neck and upper anterior chest was observed. Computed tomography of the chest showed tracheal rupture at the brachiocephalic trunk level, and bronchoscopy demonstrated a 5 cm linear tracheal defect in the posterior membranous wall, 6 cm proximal to the carina. Surgical repair of the tracheal injury was impossible due to its location. The patient was managed with intubation, mechanical ventilator care, and antibiotics. She made a full and uncomplicated recovery and was discharged 18 days after the original injury. When suspicious symptoms appear in patients receiving mechanical ventilation support, an immediate and accurate diagnostic process should be undertaken to rule out endotracheal tube-related tracheal injuries and to avoid potentially lethal complications.

Case Presentation
A 56-year-old woman (height 146 cm, weight 74 kg) was scheduled to undergo carpal tunnel release surgery under general anesthesia. No other medical history or specific abnormal laboratory results were recorded except for the presence of arterial hypertension treated with valsartan 80 mg/day and hydrochlorothiazide 12.5 mg/day for approximately 3 months. Following induction of anesthesia with propofol 120 mg, a continuous infusion of remifentanil 10 ?10i, and fentanyl rocuronium 50 mg, the oral intubation was performed without difficulty using a 6.5 mm internal diameter (ID) high-volume/low-pressure cuffed endotracheal tube (MALLINCKRODT®, Covidien, USA) without a stylet. The cuff was inflated with 4 ml of air, but its pressure was not checked. Anesthesia was maintained with desflurane in air/O2 (FiO2 = 0.5) and remifentanil. The entire surgery lasted approximately 25 minutes......

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100632/?report=reader
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Dr. G●●●●●●●●n T●●●●●●●●●n
Dr. G●●●●●●●●n T●●●●●●●●●n Anaesthesiology
I wish to know why the patient had violent cough around extubation, whether due to rapid emergence due to all short acting agents being used, like desflurane,remifentanil, and no anxiolytic like midazolam which wasn' t mentioned in the presentation? please enlighten!
Mar 14, 2017Like