Badaoui R, Abou Arab O, Bernard E, Vouriot D, Popov I, Dupont H
Pôle d'anesthésie-réanimation, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
Ann Fr Anesth Reanim. 2013 Jun;32(6):444-6. doi: 10.1016/j.annfar.2013.04.009. Epub 2013 May 23.
Complications at extubation remain an important risk factor in anaesthesia. Airway related complications at extubation are relatively frequent but are usually dealt with by simple basic measures. We report a new case of respiratory complications associated with tracheal extubation in a 59-year-old woman. Her medical history included obesity, no criteria difficult intubation and no adverse events during her previous anesthetic procedures. At the end of surgery, immediately after extubation, the patient developed respiratory distress requiring reintubation. A second extubation performed in postoperative recovery room was complicated by a new respiratory distress with reintubation. The patient was then admitted to the ICU. The examination on admission was unremarkable. Chest X-ray and a chest CT scan were performed in search of an etiology. Both tests showed a large thyroid "goitre plongeant" (plunging goiter) and compressive. In the suites, a thyroidectomy was performed with excision of a large cervical plunging goiter para- and retropharyngeal bilateral chest, allowing extubation successfully. The postoperative course was uneventful.
拔管时的并发症仍然是麻醉中的一个重要风险因素。拔管时与气道相关的并发症相对常见，但通常通过简单的基本措施来处理。我们报告了一例59岁女性气管拔管相关呼吸并发症的新病例。她的病史包括肥胖，无困难插管标准，且之前的麻醉过程中无不良事件。手术结束时，拔管后立即出现呼吸窘迫，需要重新插管。在术后恢复室进行的第二次拔管出现新的呼吸窘迫并再次插管。然后患者被收入重症监护病房。入院检查无异常。进行胸部X线和胸部CT扫描以寻找病因。两项检查均显示一个巨大的甲状腺“坠入性甲状腺肿”（坠入性甲状腺肿）且有压迫症状。在手术室，进行了甲状腺切除术，切除了双侧颈旁和咽后坠入性巨大甲状腺肿，从而成功拔管。术后过程顺利。
