Wong D T, McGuire G P
Department of Anesthesia, Toronto Western Hospital, University of Toronto, Ontario, Canada.
Can J Anaesth. 2000 Feb;47(2):165-8. doi: 10.1007/BF03018854.
To present a case of preoperative subcutaneous emphysema (SCE) as a complication of trans-cricothyroid membrane (TCM) injection of lidocaine for awake intubation.
A 48-yr-old man with cervical myelopathy was scheduled for elective cervical discectomy. Airway topical anesthesia consisted of lidocaine pledgets and TCM injection. After successful awake fibreoptic intubation was performed, SCE was noted in the neck region. The main differential diagnosis of preoperative SCE included air leak via the anterior needle track from TCM injection or disruption of mucosal membrane in the aerodigestive tract. The latter was excluded by panendoscopy and an upper GI swallow study. The most likely explanation for SCE was air leak from the anterior needle tract. The subcutaneous emphysema resolved spontaneously without sequella.
Subcutaneous emphysema is a rare but potentially serious complication of TCM injection of lidocaine. Anesthesiologists should be familiar with the differential diagnosis, investigations and management of SCE.
报告1例术前皮下气肿，其为清醒插管时经环甲膜注射利多卡因的并发症。
一名48岁患有颈椎病的男性计划接受择期颈椎间盘切除术。气道表面麻醉包括利多卡因棉片和经环甲膜注射。成功实施清醒纤维支气管镜插管后，发现颈部区域有皮下气肿。术前皮下气肿的主要鉴别诊断包括经环甲膜注射导致的空气通过前针道漏出或上消化道黏膜破裂。通过全内镜检查和上消化道吞咽研究排除了后者。皮下气肿最可能的原因是前针道漏气。皮下气肿自行消退，无后遗症。
皮下气肿是经环甲膜注射利多卡因罕见但可能严重的并发症。麻醉医生应熟悉皮下气肿的鉴别诊断、检查和处理。
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