Massive surgical emphysema secondary to iatrogenic tracheal laceration.
A 78-year-old woman was admitted for a revision total hip replacement following a failed dynamic hip screw placed emergently 4 months earlier. Anaesthetic management consisted of general anaesthesia with endotracheal intubation and femoral nerve block. The patient's perioperative course was unremarkable except for a promptly recognised and corrected oesophageal intubation and a short period of breathing against a closed adjustable pressure limiting valve. In recovery, following a period of hypotension resistant to fluid therapy, she suddenly desaturated, developed severe facial and upper thoracic subcutaneous emphysema and type 2 respiratory failure. She was diagnosed with bilateral pneumothoraces, pneumomediastinum, pneumopericardium and surgical emphysema. This was treated emergently with supplemental oxygen and bilateral chest drains. A CT scan demonstrated a tracheal laceration, which was managed conservatively in the critical care unit. The patient had a tracheostomy on day 5 to treat an on-going air leak and later made a full recovery.
Department of Medicine, St Mary's Hospital, London, UK.
Sarah
S
Chamberlain
Department of Medicine, St Mary's Hospital, London, UK.
Habib
H
Rahman
Department of Anaesthetics, St Mary's Hospital, London, UK.
Gabriela
G
Frunza
Department of Anaesthetics, St Mary's Hospital, London, UK.
Alexander
A
Wickham
D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D022125:Lacerations / Q000150:complications*; D013352:Subcutaneous Emphysema / Q000209:etiology* / Q000628:therapy; D014132:Trachea / Q000293:injuries*; D014139:Tracheostomy / Q000379:methods; D016896:Treatment Outcome