Department of Anesthesiology, Qilu Hospital of Shandong University (Qingdao), No.758 Hefei Road, Qingdao, People's Republic of China.
Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, USA.
BMC Anesthesiol. 2019 Aug 9;19(1):149. doi: 10.1186/s12871-019-0812-9.
Tracheobronchial lacerations from trauma can be life-threatening and present significant challenges for safe anesthetic management. Early recognition of tracheal injuries and prompt airway control can be lifesaving.
A 56-year-old man with no significant medical history presented with difficulty breathing after a blunt trauma to his chest to the emergency room and was diagnosed with dislocation of the first rib and tracheal laceration after a chest tomography (CT) study. Subcutaneous emphysema in neck area quickly worsened indicating continuous air leak. Emergent surgical repair was scheduled. General anesthesia with maintaining spontaneous ventilation was performed and a 5.5 mm endotracheal tube was placed under the guidance of flexible bronchoscopy. Depth of anesthesia was maintained to achieve a Bispectral Index Score of 40-60. Once the offending first rib was removed, a 7.5 mm endotracheal tube was inserted distal to the laceration site with the guidance of flexible bronchoscopy. Once confirmed location of the endotracheal tube, cisatracurium was administered intravenously and the patient was managed on mechanical ventilation with interval positive pressure ventilation. The operation was successful and he was transferred to the ICU intubated. He then received elective surgical repairs for sternum fracture, multiple rib fractures and hemopneumothorax under general anesthesia on day 5 after the first surgery and was extubated on postoperative day 7. The subsequent course was uneventful. Comprehensive rehabilitation was done for 2 weeks and he was discharged home on postoperative day 41.
Early diagnosis and multidisciplinary collaborations are keys to the successful management of this patient. Flexible bronchoscopy is particularly useful in airway management for urgent trachea tracheal laceration repair.
创伤引起的气管支气管裂伤可能危及生命，并对安全的麻醉管理提出重大挑战。早期识别气管损伤并及时进行气道控制可能是救命的。
一名 56 岁男性，无明显病史，因胸部钝挫伤到急诊室就诊后出现呼吸困难，并在胸部 CT 研究后诊断为第 1 肋骨脱位和气管裂伤。颈部皮下气肿迅速恶化，表明持续漏气。紧急手术修复。在维持自主呼吸的全身麻醉下进行，在纤维支气管镜引导下放置 5.5mm 气管内管。麻醉深度维持在双频谱指数评分 40-60。一旦去除有问题的第 1 肋骨，在纤维支气管镜引导下，将 7.5mm 气管内管插入裂伤部位远端。一旦确认气管内管的位置，静脉给予顺阿曲库铵，患者在机械通气下进行间歇性正压通气。手术成功，他被插管转入 ICU。然后，在第一次手术后第 5 天，他在全身麻醉下接受了胸骨骨折、多发肋骨骨折和血气胸的择期手术修复，并在术后第 7 天拔管。随后的过程顺利。进行了 2 周的综合康复治疗，他在术后第 41 天出院回家。
早期诊断和多学科合作是成功治疗该患者的关键。纤维支气管镜在紧急气管裂伤修复的气道管理中特别有用。
