Ankay Yilbas Aysun, Kanburoglu Cigdem, Uzumcugil Filiz, Cifci Coskun, Saralp Ozge Ozen, Karagoz Heves, Akinci Seda Banu, Arat Anil
Hacettepe University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turquia.
Hacettepe University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turquia.
Braz J Anesthesiol. 2018 Mar-Apr;68(2):194-196. doi: 10.1016/j.bjan.2016.12.003. Epub 2016 Dec 23.
Cervical hematomas can lead to airway compromise, a life threatening condition, regardless of the cause. The following case is the first presentation of cervical hematoma as a complication of endovascular treatment of middle cerebral artery aneurysm.
A 49 year-old woman was scheduled for stent placement under general anesthesia for middle cerebral artery aneurysm. Few days before intervention, acetyl salicylic acid and clopidogrel treatment was started. Following standard monitoring and anesthesia induction, the patient's trachea was intubated with a 7.5 mm endotracheal tube and the procedure was completed without any complications. Three hours later, dyspnea developed and physical examination revealed progressive swelling and stiffness in the neck. Endotracheal intubation was performed with a 6 mm diameter uncuffed tube with the aid of sedation. The vocal cords were completely closed due to compression. There was no leak around the endotracheal tube. The rapidly performed computerized tomography scans showed an enormous hematoma around the neck and extravasation of contrast medium through superior thyroid artery. After coil embolization of superior thyroid artery, she was taken to the intensive care unit as intubated and sedated. Surgical exploration of the hematoma was not recommended by the surgeons, because she was on clopidogrel. After two days, the patient's trachea was extubated safely ensuring that the swelling was sufficiently ceased and leak detected around the endotracheal tube.
Securing the airway rapidly by endotracheal intubation is the most crucial point in the management of cervical hematomas. Diagnostic and therapeutic procedures should be performed only afterwards.
无论病因如何，颈部血肿都可能导致气道受压，这是一种危及生命的情况。以下病例是首次将颈部血肿作为大脑中动脉动脉瘤血管内治疗的并发症进行报道。
一名49岁女性计划在全身麻醉下进行大脑中动脉动脉瘤支架置入术。干预前几天开始使用阿司匹林和氯吡格雷治疗。在进行标准监测和麻醉诱导后，用一根7.5毫米的气管内导管对患者进行气管插管，手术顺利完成，无任何并发症。三小时后，患者出现呼吸困难，体格检查发现颈部逐渐肿胀和僵硬。在镇静辅助下，使用一根直径6毫米的无套囊导管进行气管插管。由于受压，声带完全闭合。气管内导管周围无漏气。快速进行的计算机断层扫描显示颈部有巨大血肿，造影剂通过甲状腺上动脉外渗。在对甲状腺上动脉进行弹簧圈栓塞后，患者被插管并镇静后送入重症监护病房。外科医生不建议对血肿进行手术探查，因为患者正在服用氯吡格雷。两天后，在确保肿胀充分消退且气管内导管周围无漏气后，患者安全拔管。
通过气管插管迅速确保气道安全是颈部血肿管理中最关键的一点。诊断和治疗程序应仅在其后进行。
