Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan.
Department of Orthopaedic Surgery, Osaka National Hospital, Osaka, Japan.
JBJS Case Connect. 2020 Jul-Sep;10(3):e20.00236. doi: 10.2106/JBJS.CC.20.00236.
A 48-year-old woman underwent anterior cervical discectomy and fusion at C5/6. Extubation was performed immediately after surgery. Tachycardia, limb tremor, and panic attack developed approximately 4 hours after surgery at 16:15. Thirty minutes later, cessation of respiration occurred at 16:50. An experienced anesthesiologist attempted intubation but was unsuccessful because of laryngopharyngeal edema at the C2 level. Finally, an otolaryngologist performed tracheotomy and secured the airway at 17:20 but hypoxic encephalopathy ensued.
Predicting the airway obstruction caused by laryngopharyngeal edema was very difficult; hence, to prevent critical complications, systematic perioperative management is essential in anterior cervical spine surgery.
一名 48 岁女性在 C5/6 行前路颈椎间盘切除术和融合术。手术结束后立即拔管。术后约 4 小时，即 16:15，患者出现心动过速、肢体震颤和惊恐发作。30 分钟后，即 16:50，呼吸停止。一位经验丰富的麻醉师试图进行插管，但由于 C2 水平的咽后水肿，未能成功。最后，耳鼻喉科医生在 17:20 进行了气管切开术并固定了气道，但随后出现缺氧性脑病。
预测咽后水肿引起的气道阻塞非常困难；因此，为了预防严重并发症，在前路颈椎手术中必须进行系统的围手术期管理。
