Anaesthesia for major orthopaedic surgery in a child with an acute tracheobronchial injury.
A 12-year-old boy presented after a motorbike accident with mediastinal and cervical emphysema but no pneumothorax, minor head injury and several fractures including a comminuted open leg fracture. The child had no signs of respiratory compromise and was stable. The presumed tracheobronchial injury was managed conservatively. To avoid general anaesthesia and the risks associated with intubation and ventilation, urgent surgery for correction of his orthopaedic injuries was successfully conducted under spinal, epidural and intravenous regional anaesthesia. The surgical and anaesthetic management of tracheobronchial injury is complex and controversial.
Graham
J
J
Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria.
Davidson
A J
AJ
D000063:Accidents, Traffic; D000765:Anesthesia, Conduction / Q000379:methods*; D000767:Anesthesia, Epidural / Q000379:methods; D000771:Anesthesia, Intravenous / Q000379:methods; D000775:Anesthesia, Spinal / Q000379:methods; D001980:Bronchi / Q000293:injuries; D002648:Child; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D018570:Risk Assessment; D013898:Thoracic Injuries / Q000175:diagnosis / Q000601:surgery*; D014132:Trachea / Q000293:injuries; D016896:Treatment Outcome