Lee Hwaseon, Jo Hyunmi
Department of Oral and Maxillofacial Surgery, Yongin Severance Hospital, Yongin, Korea.
Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.
J Korean Assoc Oral Maxillofac Surg. 2024 Oct 31;50(5):297-302. doi: 10.5125/jkaoms.2024.50.5.297.
This study discusses laryngospasm following orthognathic surgery and requiring emergency intubation, followed by systemic complications due to a hypoxic event. A 34-year-old male patient underwent orthognathic surgery due to facial asymmetry. When emerging from general anesthesia, blood pressure elevated suddenly, and severe agitation occurred. After extubation, desaturation occurred immediately, resulting in cyanosis and loss of consciousness. An emergency cricothyroidotomy was performed, and oral intubation was required to maintain the airway. The patient was sent to the intensive care unit on a ventilator. On postoperative day 2, the red blood cell count and hemoglobin level decreased significantly. Electrocardiogram showed abnormalities, although vital signs were stable and no bleeding was observed. Laryngospasm often occurs under general anesthesia, resulting in sustained closure of the vocal cords and obstruction of the airway. This condition can be life-threatening, and awareness of the various precipitating factors is important. Orthognathic surgery is a risk factor for laryngospasm because its surgical site affects the airway, and it involves discharge of blood via intraoral wounds. It is important to understand systemic changes occurring after a hypoxic event, and consultation with specialists from various departments should be actively pursued.
本研究讨论正颌外科手术后发生喉痉挛并需要紧急插管，随后因缺氧事件导致全身并发症的情况。一名34岁男性患者因面部不对称接受正颌外科手术。全身麻醉苏醒时，血压突然升高，并出现严重躁动。拔管后立即出现血氧饱和度下降，导致发绀和意识丧失。紧急实施了环甲膜切开术，并需要经口插管以维持气道通畅。患者被送至重症监护病房并使用呼吸机。术后第2天，红细胞计数和血红蛋白水平显著下降。心电图显示异常，尽管生命体征稳定且未观察到出血情况。喉痉挛常在全身麻醉下发生，导致声带持续关闭和气道阻塞。这种情况可能危及生命，了解各种诱发因素很重要。正颌外科手术是喉痉挛的一个危险因素，因为其手术部位会影响气道，且涉及经口腔伤口出血。了解缺氧事件后发生的全身变化很重要，应积极寻求各科室专家的会诊。
