Sengupta Saikat, Saikia Anjol, Ramasubban Suresh, Gupta Shaikat, Maitra Sudipta, Rudra Amitava, Maitra Gaurab
Department of Anaesthesiology, Perioperative Medicine and Pain, Apollo Gleneagles Hospitals, Kolkata, India.
Ann Card Anaesth. 2008 Jul-Dec;11(2):123-6. doi: 10.4103/0971-9784.41582.
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.
钝性胸部创伤后行全气管切除术极为罕见。高度怀疑对于识别这些病例至关重要，早期干预与更好的预后相关。我们报告一例全气管切除术患者，在患者清醒且在纤维支气管镜引导下自主呼吸的情况下确保了气道安全。作为预防措施，我们已准备好体外循环设备。在气管修复过程中，麻醉管理需要调整，采用丙泊酚和罗库溴铵输注的全静脉麻醉，并在气管重建时将另一根气管导管插入气管远端。不能使用常规的吸入技术。处理此类病例的麻醉医生应意识到确保气道安全和气管修复过程中的困难。妥善规划并准备好备用方案有助于成功管理这些患者。
