Difficult Airway Management with Neck Swelling after Carotid Endarterectomy

Airway problems after carotid endarterectomy

“…Fortunately, there were no long-term sequelae as a result of this delay in securing the airway. However, in a previous report of six similar cases, four of which were initially paralysed resulting in inability to ventilate the lungs, all suffered severe hypoxia and cardiac arrhythmias [4]. In three of these the trachea was intubated with difficulty using small tracheal tubes and one underwent emergency tracheostomy while asystolic.…”

“…Previous reports have postulated that the aetiology of airway obstruction after carotid endarterectomy surgery may be direct tracheal compression by haematoma, oedema secondary to either direct mucosal trauma or lymphatic and venous congestion resulting from haematoma formation [4,5]. Reports suggesting oedema as the primary causal factor have described evacuation of haematoma which did not immediately relieve the airway obstruction; indeed 10 h of elective ventilation after operation has been recommended [6].…”

Extubation and Reintubation of the Difficult Airway

“…O'Sullivan and coworkers reported a similar experience for six patients with airway obstruction after carotid endarterectomy. 188 Stridor was not relieved by wound evacuation. Administration of muscle relaxants made manual mask ventilation and tracheal intubation virtually impossible due to marked glottic or supraglottic edema.…”

Extubation and Changing Endotracheal Tubes

“…O'Sullivan and coauthors described six patients with airway obstruction after carotid endarterectomy. 204 Five of these patients had been taking antiplatelet drugs preoperatively. They found that stridor was not relieved by wound evacuation.…”