Inoue Satoki, Fujimoto Yuko, Kawano Yasunobu, Furuya Hitoshi
Department of Anesthesiology, Nara Medical University, 840 Shijo-cho Kashihara Nara 634-8522, Japan.
Middle East J Anaesthesiol. 2011 Feb;21(1):125-7.
A 60 yr-old male underwent anterior cervical fusion under general anesthesia. Neck swelling was observed at the next morning. Subsequently, emergent CT scanning was performed, which revealed a retropharyngeal hematoma narrowing the upper airway and right anterior neck hematoma significantly deviating the trachea and larynx. Nasal intubation was attempted but difficult passage of the endotracheal tube counteracted this procedure. Immediately, massive nasal bleeding occurred, which worsened the situation. Subsequently, oral fiberoptic intubation with the aid of McCoy type laryngoscope was tried and intubation was barely established. The patient was submitted to emergent evacuation of the hematoma. Reevaluation of the preoperative CT images showed the nasal cavity narrowing because of widespread nasal mucosal swelling. It is necessary to anticipate that nasal mucosal swelling and bleeding tendency due to impairment of venous drainage can exist in such a case.
一名60岁男性在全身麻醉下接受了颈椎前路融合术。第二天早晨发现颈部肿胀。随后进行了急诊CT扫描，结果显示咽后血肿使上呼吸道变窄，右前颈部血肿使气管和喉部明显移位。尝试进行鼻插管，但气管导管难以通过，阻碍了该操作。随后，立即发生大量鼻出血，使情况恶化。随后，尝试借助麦考伊型喉镜进行口腔纤维光导插管，勉强完成了插管。患者接受了血肿的紧急清除。术前CT图像的重新评估显示，由于广泛的鼻黏膜肿胀，鼻腔变窄。在这种情况下，有必要预料到可能存在因静脉引流受损导致的鼻黏膜肿胀和出血倾向。
