Royal academy of medicine in Ireland section of anaesthesia

Abstract

An 80 year old female presented with the clinical featmes of a perforated intra-abdominal viscus. Following rapid sequence of anaesthesia the larynx was visualised but an endotracheal tube could not be passed below the level of the cricoid. The registrar called the consultant__ and proceeded to manually ventilate the patient with 1 0(Oo o~(ygen via the face mask. Gross subcutaneous emphysema of the neckand upper trunk then developed and the patient became cyanose& Despite the inconclusive chest X-ray bilateral chest drains were inserted. The patient resumed spontaneous respiration and her condition improved.Following re-inroduction of anaesthesia a 6.0 endotracheal tube was passed. Bronchoscopy and laryngoscopy revealed no evidence of trauma. There was no difficulty with ventilation via the tube anaesthesia being maintained with oxygen, nitrous oxide, enflurane and pancuronium. Subcutaneous emphysema increased initially after intubation, thereafter anaesthesia proceeded uneventfully and laparotomy revealed alarge hiatus and perforation of the intrathoracic stomach.