Department of Anesthesiology, Resuscitation, Intensive Medicine and Pain Therapy, Zagreb University Hospital Center, Zagreb, Croatia.
Acta Clin Croat. 2023 Apr;62(Suppl1):165-169. doi: 10.20471/acc.2023.62.s1.23.
Central venous catheterization (CVC) of the internal jugular vein is an invasive procedure commonly performed in anesthesiology practice. Usually it is an uneventful procedure but complications such as bleeding, infection, and potential damage to the surrounding structures can occur. One of the complications is neck hematoma, which can distort airway anatomy and cause upper airway obstruction. We present a patient who underwent endovascular mitral valve repairment procedure under general anesthesia. Accidental puncture of carotid artery occurred while attempting to place the central line. Later, during awakening in the coronary intensive care unit, the patient developed neck hematoma. The diagnosis was confirmed with multi-slice computed tomography (MSCT) and MSCT angiography showed active arterial blood extravasation. Despite it, the patient was extubated. Awake tracheal intubation (ATI) with video laryngoscopy was the technique of choice for reintubation because of the neck swelling and compression onto laryngeal structures. In this case, rushed extubation put the patient at risk. Video laryngoscopy ATI with appropriate preparation and titrated sedation can enable quick and safe rescue airway management in patients with rapidly developing neck hematoma, along with definitive evacuation and treatment.
颈内静脉中心静脉置管（CVC）是麻醉科常用的有创操作。通常情况下，这是一个无并发症的过程，但也可能会出现出血、感染和潜在的周围结构损伤等并发症。其中一种并发症是颈部血肿，它会使气道解剖结构变形，导致上呼吸道阻塞。我们介绍一位在全身麻醉下接受经皮二尖瓣修复术的患者。在尝试置管时意外刺穿了颈动脉。之后，在冠心病重症监护病房苏醒时，患者出现了颈部血肿。通过多层螺旋 CT（MSCT）和 MSCT 血管造影得到确诊，显示有动脉血液外渗。尽管如此，患者还是被拔管了。由于颈部肿胀和对喉部结构的压迫，可视喉镜下清醒经口气管插管（ATI）成为重新插管的首选技术。在这种情况下，匆忙拔管会使患者处于危险之中。在快速发展的颈部血肿患者中，通过适当的准备和滴定镇静，可以使用视频喉镜 ATI 进行快速、安全的气道管理，并进行明确的血肿清除和治疗。
