[Anesthetic management of a patient with gunshot injury in the neck and the chest].
We present a case of a 27-year-old man with gunshot injury in the neck and the chest. On admission, he had an entry wound in the neck and his chest radiograph showed left hemopneumothorax. Nasal endotracheal intubation and chest drainage were immediately performed. Angiography revealed pseudoaneurysm of the left carotid artery and fistula between the artery and the innominate vein. The patient showed progressive severe facial edema due to the fistula. Anesthesia was induced and maintained with fentanyl and sevoflurane. The carotid artery was repaired with an autologous saphenous vein graft. Although one lung ventilation (OLV) was requested for partial resection of the left lung, replacing the endotracheal tube was impossible due to severe facial edema. OLV was successfully performed by blocking the left main trunchus with a 7 Fr Fogarty catheter placed under fiberscopic monitoring. The patient recovered without any serious complications. Prompt and proper airway management is required in gun shot injury of the neck and chest.
Hasegawa
N
N
Department of Anesthesiology, Faculty of Medicine, University of Tokyo, Tokyo 113-8655.
Sawamura
S
S
Hagihara
R
R
Hanaoka
K
K
D000328:Adult; D000758:Anesthesia; D019917:Blood Vessel Prosthesis Implantation; D002339:Carotid Arteries / Q000601:surgery; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D019838:Neck Injuries / Q000601:surgery*; D011013:Pneumonectomy; D013898:Thoracic Injuries / Q000601:surgery*; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000601:surgery*