International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.
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ABSTRACTIntroduction: Difficulties and complications associated with intubation are among the leading causes of surgery-related mortality in patients with obesity and obstructive sleep apnea. It is known that during perioperative intubations, the progression of the bougie may lead to serious injury and even rupturing in the trachea. Case Report: A 46-year-old ASA II patient was assessed preoperatively for uvuloplasty. His body mass index was 34.7. Preparation was completed for the difficult intubation. The patient could not directly intubated with laryngoscopy but was intubated with bougie in the second trial. After the surgery 200 mg bridion was administered and the patient was extubated. He was then followed-up in PACU. Due to the stridor, it was thought that there was edema in his upper airway. At 45 minutes of PACU follow-up, it was noticed that upper airway edema regressed but there was subcutaneous emphysema giving a sense of rattle during palpation in the periphery of the right eye. It spread rapidly over the face. Afterwards he was intubated again through video laryngoscopy due to the risk of upper airway obstruction. Fiber optic examination and thorax tomography revealed that the fistula line was on the left lateral wall following cricoid cartilage. Mucosal damage of the patient healed spontaneously and weaning was conducted three days later in the ICU. Conclusion: It was reported that tracheal injury and rupture occurs due to 'blind' advancement of the bougie during intubation. Due to the identification of subcutaneous emphysema at 45 minutes during follow-up, it was thought that the bougie caused injury in the patient. The close long-term postoperative follow-up is important in cases where difficult intubation is conducted with bougie and intubation is achieved through multiple trials.
Mitral kapakta tromboz nedeniyle stuck kapak saptanan ve buna bağlı olarak akut kalp yetmezliği ve pulmoner ödem tablosunda acil ameliyata aldığımız 28 haftalık gebenin anestezi yönetimi sunulmuştur. Nefes darlığı yakınması ile başvuran 28 haftalık gebe, MVR (mitral valve replacement) stuck kapak saptanması üzerine acil ameliyat için hastanemize sevkedilmiştir. Transtorasik ekokardiyografisinde EF %55, protez mitral kapak disfonksiyene, açılımı kısıtlı, sağ boşlukları ileri derecede dilate, pulmoner arter basıncı 65 mmHg, 2.-3. derece aort yetmezliği, 2. derece triküspit yetmezliği mevcuttu. Ameliyat masasına alınan hastada, ekstremite uçlarında ve dudaklarda hafif siyanoz, takipne, ortopne ve hemoptizi mevcuttu. Batın ultrasonografide uterusta 28 haftalık canlı fetüs olduğu tespit edildi. Hastanın, isteği doğrultusunda trombolitik tedavi başlanmadı. Genel anestezi altında önce sezaryen ile bebek canlı olarak doğurtuldu ve ardından kardiyopulmoner baypass ile mitral kapak değişimi yapıldı. Nonfonksiyone mitral kapak nedeniyle ameliyata aldığımız gebede uygun bir anestezi ve cerrahi planlama yapılarak anne ve bebekte komplikasyon yaşanmadan operasyon tamamlandı.
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