Noguchi Satoko, Saito Junichi, Kawaguchi Jun, Kushikata Tetsuya, Hirota Kazuyoshi
Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
JA Clin Rep. 2020 May 22;6(1):37. doi: 10.1186/s40981-020-00343-6.
Tracheo-innominate artery fistula (TIF) is a life-threatening complication of tracheostomy. We describe perioperative management for innominate artery transection in a case with TIF.
A 4-year-old Japanese female with Marshal-Smith syndrome presented for management of TIF. She underwent tracheostomy at the age of 3 months and an uncuffed tracheostomy tube was inserted. One month before admission to our hospital, intermittent tracheal bleeding, suggesting TIF, occurred. Although we considered to change to a cuffed endotracheal tube, craniofacial abnormality suggested difficult oral intubation, and there was a possibility of rebleeding. Finally, innominate artery transection was performed under total intravenous anesthesia without changing the tracheostomy tube. Surgery completed uneventfully and she received mechanical ventilation under sedation for a day, followed by weaning without complications.
A cuffed tracheostomy tube should have been inserted before surgery for effective hemostasis against sudden bleeding from TIF even though conversion to oral intubation was difficult.
气管无名动脉瘘（TIF）是气管切开术的一种危及生命的并发症。我们描述了一例TIF患者无名动脉横断的围手术期管理。
一名患有马歇尔-史密斯综合征的4岁日本女性因TIF前来治疗。她在3个月大时接受了气管切开术，并插入了无套囊气管切开管。入院前一个月，出现间歇性气管出血，提示TIF。尽管我们考虑更换为带套囊的气管内导管，但颅面异常提示经口插管困难，且有再次出血的可能。最后，在全静脉麻醉下进行无名动脉横断术，未更换气管切开管。手术顺利完成，她在镇静下接受了一天的机械通气，随后顺利脱机，无并发症。
即使经口插管困难，术前也应插入带套囊的气管切开管，以有效止血，防止TIF突然出血。
