Anaesthetic management of a patient with complete tracheal rupture following blunt chest trauma.
Complete tracheal resection is extremely rare after blunt chest trauma. A high degree of suspicion is essential to identify these cases and early intervention is associated with better outcome. We report a patient with complete tracheal resection, in whom the airway was secured whilst the patient remained awake, breathing spontaneously under fibreoptic bronchoscopic guidance. As a precautionary measure, we had kept cardiopulmonary bypass set up in readiness. Anaesthetic management needed to be modified during repair of the trachea, by using total intravenous anaesthesia with propofol and rocuronium infusion and insertion of a separate endotracheal tube into the distal portion of the trachea whilst reconstruction of the trachea took place. The usual inhalational technique could not be used. The anaesthesiologist managing such a case should be aware of the difficulties during securing the airway and during repair of the trachea. Proper planning and keeping back-up plans ready helps in successful management of these patients.
Sengupta
Saikat
S
Department of Anaesthesiology, Perioperative Medicine and Pain, Apollo Gleneagles Hospitals, Kolkata, India. saikatsg@gmail.com
Saikia
Anjol
A
Ramasubban
Suresh
S
Gupta
Shaikat
S
Maitra
Sudipta
S
Rudra
Amitava
A
Maitra
Gaurab
G
D000328:Adult; D000732:Androstanols / Q000627:therapeutic use; D000758:Anesthesia / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D001999:Bronchoscopy; D006801:Humans; D008297:Male; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use; D015742:Propofol / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000379:methods; D000077123:Rocuronium; D012421:Rupture; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000293:injuries* / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*
D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium; D015742:Propofol