Airway Management in Patients Who Develop Neck Hematomas After Carotid Endarterectomy

Shakespeare, William A.; Lanier, William L.; Perkins, William J.; Pasternak, Jeffrey J.

doi:10.1213/ane.0b013e3181c85128

Cited by 44 publications

(21 citation statements)

References 20 publications

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“…Shakespeare et al. reviewed 44 cases of neck hematomas requiring postoperative exploration arising as a complication of endarterectomy of which only 36% were due to arterial bleeding. The authors also suggested that venous congestion may distort the airway and cause obstruction.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Cervical Soft Tissue Hemorrhage with Acute Upper Airway Obstruction

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Byard

2012

Journal of Forensic Sciences

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Cervical surgery may be complicated by acute upper airway obstruction due to hematoma formation. Two cases are reported following cervical surgery where stridor, respiratory distress, and lethal airway occlusion resulted from hemorrhage that did not arise from large vessels. Case 1: A 50-year-old man who had an elective anterior fusion of C5-6 vertebrae developed marked neck swelling and stridor. At autopsy, there was significant cervical interstitial hemorrhage and edema. Major vessels were intact. Case 2: An 86-year-old man who underwent a carotid endarterectomy developed stridor and swelling of his neck. At autopsy, there was extensive interstitial hemorrhage and edema within the soft tissues of the neck. The endarterectomy site was intact. Both deaths were due to upper airway obstruction from postoperative cervical interstitial hemorrhage with no large vessel damage identified. Hemorrhage from small vessels may therefore lead to critical soft tissue hematoma formation and edema with airway obstruction and death.

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Section: Discussionmentioning

confidence: 99%

Postoperative Cervical Soft Tissue Hemorrhage with Acute Upper Airway Obstruction

Quick

Byard

2012

Journal of Forensic Sciences

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“…Post-operative hemorrhage can be associated with significant drain output, suture line bleeding, progressive swelling of the anterior neck and submandibular region, facial edema/plethora and tracheal deviation [7, 9-11]. Sudden hemodynamic instability has been observed in the setting of an expanding neck hematoma after anterior cervical surgery.…”

Section: Diagnostic Considerationsmentioning

confidence: 99%

“…This situation typically involves a patient who is extubated immediately after surgery and then develops respiratory distress after transfer to the post-anesthesia care unit or the surgical ward. The time to onset of this complication (< 12 hours after surgery) is such that the on-site night staff will often have responsibility for acute management of the patient [7, 9, 11]. …”

Section: Management Of Postoperative Airway Compromisementioning

confidence: 99%

Airway Compromise Due to Wound Hematoma Following Anterior Cervical Spine Surgery

Palumbo

Aidlen²,

Daniels³

et al. 2012

TOORTHJ

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One of the most serious adverse events associated with anterior cervical spine surgery is wound hematoma resulting in airway compromise. The reported incidence of this postoperative complication has varied from 0.2% to 1.9%. Obstruction of the airway secondary to bleeding presents a challenging clinical scenario given the rapidity of onset, distorted anatomy of the upper respiratory tract, urgent need to act and potential for catastrophic consequences. This high-risk, life-threatening clinical scenario requires specialized knowledge and a well-designed treatment protocol to achieve a positive outcome. In this review, we report a case of airway compromise secondary to wound hematoma following anterior cervical discectomy and fusion, followed by a review of relevant literature, anatomy, etiologic factors and diagnostic considerations. We also propose guidelines for the prevention and management of postoperative airway obstruction due to wound hematoma.

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“…Successful tracheal intubation can be challenging in patients with a postoperative neck haematoma [3]. In addition, neck surgery disrupts lymphatic drainage, which can lead to swelling of the tracheal mucosa, supraglottic airway, glottic aperture and structures in the anterior part of the neck [4,5].…”

Section: Discussionmentioning

confidence: 99%

Topical anaesthesia in patients with post‐thyroidectomy haemorrhage using the “spray‐as‐you‐go” technique

et al. 2014

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Postoperative haematoma following thyroidectomy is an uncommon but potentially life-threatening complication. In such cases, awake fibreoptic intubation may be an option. We report our experience of performing awake fibreoptic nasal intubation in two patients with post-thyroidectomy haemorrhage. We have designed a novel topical anaesthesia catheter that can pass through the working channel of the fibreoptic bronchoscope in order to apply topical solution to the airway mucosa. Topical anaesthesia was applied to the airway using a "spray-as-you-go" technique via this catheter.

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Airway Management in Patients Who Develop Neck Hematomas After Carotid Endarterectomy

Cited by 44 publications

References 20 publications

Postoperative Cervical Soft Tissue Hemorrhage with Acute Upper Airway Obstruction

Postoperative Cervical Soft Tissue Hemorrhage with Acute Upper Airway Obstruction

Airway Compromise Due to Wound Hematoma Following Anterior Cervical Spine Surgery

Topical anaesthesia in patients with post‐thyroidectomy haemorrhage using the “spray‐as‐you‐go” technique

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