Neck Hematoma Causing Acute Airway and Hemodynamic Compromise After Anterior Cervical Spine Surgery

Sethi, Rajesh; Tandon, Monica; Ganjoo, Pragati

doi:10.1097/ana.0b013e318157f749

Cited by 32 publications

(18 citation statements)

References 5 publications

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“…In other instances, a hematoma can form after surgery irrespective of adequate intraoperative hemostasis. Postoperative hemorrhage may occur secondary to coagulopathy, increased blood pressure during emergence from anesthesia, or elevated venous pressure due to the Valsalva effect of coughing at the time of extubation [7]. …”

Section: Etiologymentioning

confidence: 99%

“…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%

“…Sudden hemodynamic instability has been observed in the setting of an expanding neck hematoma after anterior cervical surgery. In the report by Sethi et al , bradycardia and hypotension was attributed to mechanical distortion of the carotid sinus with activation of the baroreceptor reflex [7]. …”

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%

See 3 more Smart Citations

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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Section: Etiologymentioning

confidence: 99%

Section: Diagnostic Considerationsmentioning

confidence: 99%

Section: Diagnostic Considerationsmentioning

confidence: 99%

Section: Management Of Postoperative Airway Compromisementioning

confidence: 99%

See 2 more Smart Citations

Airway Compromise Due to Wound Hematoma Following Anterior Cervical Spine Surgery

Palumbo

Aidlen²,

Daniels³

et al. 2012

TOORTHJ

View full text Add to dashboard Cite

show abstract

“…Some authors attribute this respiratory distress to supraglottic lymphovenous oedema, secondary to the internal jugular vein (IJV) obstruction 2 12. However, it takes hours for this oedema to set in, to the extent of being symptomatic,13 making this an unlikely cause for acute distress seen in immediate postoperative haematomas. Besides, in many reported cases of respiratory distress secondary to postoperative neck haematoma, comprising both thyroid and non-thyroid surgeries, the airway could be successfully secured by emergency endotracheal intubation 13–15.…”

Section: Discussionmentioning

confidence: 99%

Cushing’s reflex secondary to neck haematoma following thyroidectomy

et al. 2018

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Neck haematoma following thyroid surgery can present with respiratory distress which is generally attributed to airway obstruction. We recently had a 63-year-old female patient who underwent total thyroidectomy for toxic nodular goitre. However, within 4 hours of surgery, she developed sudden respiratory distress which was managed by prompt evacuation of the neck haematoma. Just before the haematoma evacuation, the patient had hypertension and bradycardia along with the distress. The arterial blood gas analysis sampled at that time was normal. Intraoperatively, the tracheal framework was found rigid and non-pliable. Considering the various clinical–biochemical findings observed, we think that the cause of the respiratory distress in the index case was transiently elevated intracranial pressure, secondary to bilateral internal jugular veins' compression. We hypothesise that in many patients with immediate postoperative neck haematoma, the Cushing’s reflex would at least contribute partly, if not solely to the respiratory distress.

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