Anaesthetic management of a patient with complete tracheal rupture following blunt chest trauma

Abstract

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.

Thoracic Anesthesia and Cross Field Ventilation for Tracheobronchial Injuries: A Challenge for Anesthesiologists

“…The most common presentations are dyspnea and subcutaneous emphysema [13, 14]. Other symptoms may include hoarseness, signs of external trauma, stridor, pneumothorax, pneumomediastinum or pneumopericardium, oxygen desaturation, cyanosis, and hemoptysis [15]. Extra-anatomic air is present in approximately 90% at the time of chest radiography [6].…”

Fiberoptic Intubation: An Overview and UpdateDiscussion

“…Such conventional techniques may then lead to severe or catastrophic complications, including massive subcutaneous emphysema and airway loss. Sengupta et al 27 reported a patient with complete tracheal disruption after blunt trauma in which the injury was identified during an awake FOI, facilitating precise ETT placement and positioning. Other reports have described soft tissue swelling and hematoma causing airway obstruction in patients with cervical spine injuries.…”

Clinical analysis of eight patients with blunt main stem bronchial injuries

“…It was reported that blunt main stem bronchus injuries are not diagnosed immediately in 25% to 68% of the cases (8). The clinical manifestations are non-specific and can vary from chest pain, cough, respiratory distress, dyspnea, haemoptysis to mediastinal emphysema, subcutaneous emphysema or pneumothorax (9). Almost all of the patients suffered from chest pain.…”