Department of Anesthesia, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2011 Nov;58(11):1029-33. doi: 10.1007/s12630-011-9570-y. Epub 2011 Aug 6.
We describe an unusual combination of dynamic supraglottic, glottic, subglottic, and intrathoracic airway obstructions following a total thyroidectomy. These problems were anticipated, documented videographically, and managed preemptively.
Following a total thyroidectomy, we replaced the endotracheal tube with a laryngeal mask airway, namely, the LMA-Classic™, in a patient with symptomatic tracheal compression and probable obstructive sleep apnea. Spontaneous ventilation was observed bronchoscopically through the LMA-Classic. Supraglottic swelling, extraglottic collapse on inspiration, and intrathoracic collapse on expiration were documented prior to recovery. These observations were of sufficient concern to warrant reinsertion of the endotracheal tube and subsequent tracheal extubation over a tube exchanger. Thereafter, we provided face-mask continuous positive airway pressure using a Boussignac mask with an endotracheal ventilation catheter in situ.
Acute airway collapse following thyroid surgery is a rare and potentially serious complication. Diagnosis by conventional methods may be insensitive. Difficulties may not be apparent until the patient becomes distressed after tracheal extubation, and this circumstance will worsen airway compromise. In such a state, re-establishing the airway can become life-threatening. We describe the preemptive identification, physiologic manifestations, and management of the supraglottic and subglottic obstruction exemplified by this case.
我们描述了一例全甲状腺切除术后罕见的动态会厌、声门、声门下和胸内气道阻塞的综合表现。这些问题是可以预见的，并通过录像进行了记录，且采取了预防性的处理措施。
在全甲状腺切除术后，我们为一名有症状性气管受压和可能的阻塞性睡眠呼吸暂停的患者更换了喉罩气道，即 LMA-Classic™。通过 LMA-Classic 进行支气管镜检查时观察到自主通气。在恢复前，记录到了会厌肿胀、吸气时会厌外塌和呼气时胸内塌陷。这些观察结果引起了足够的关注，需要重新插入气管内导管，并通过管交换器随后进行气管拔管。此后，我们通过原位插入气管内通气导管的 Boussignac 面罩提供面罩持续气道正压通气。
甲状腺手术后急性气道塌陷是一种罕见且潜在严重的并发症。传统方法的诊断可能不敏感。在气管拔管后患者感到不适之前，可能不会出现明显的困难，而这种情况会使气道阻塞恶化。在这种情况下，重新建立气道可能会危及生命。我们描述了这例病例中所体现的会厌和声门下阻塞的预防性识别、病理生理表现和处理。
