ABSTRACT
A 22-year-old male patient was admitted for reconstructive surgery after primary orbital fracture operation.Following uneventful intraoperative procedure except postextubation laryngospasm, in PACU area, there were alternately frustrating and confusing events of several times of projectile vomiting of considerable amount of dark blood and hemoptysis with forceful coughing.On rigid nasal endoscopic examination after investigative gastric endoscopy and bronchoscopy, intranasal bleeding at the point of the middle turbinate was found, highly suggestive of anterior ethmoidal artery injury during the operation.Presumably blood swallowing with restoration of spontaneous respiration during emergence and aspiration after extubation resulted in these different features of hematemesis and pseudohemoptysis, respectively.In conclusion, one must keep in mind the potentially dangerous but preventable swallowing and aspiration during the course of emergence and recovery after general anesthesia for surgery or accompanying injury of orofacial structures.
Subject(s)
Humans , Male , Young Adult , Anesthesia, General , Arteries , Bronchoscopy , Deglutition , Endoscopy , Hematemesis , Hemoptysis , Hemorrhage , Laryngismus , Orbital Fractures , Respiration , Turbinates , VomitingABSTRACT
Endotracheal obstruction may cause serious complications, including cardiovascular instability, pneumothorax, pulmonary edema and even brain death. A 21-year-old man was scheduled to undergo an open reduction for an orbital fracture. The patient had tracheostomy with an 8.0 mm tracheostomy tube 3 weeks ago and was breathing well spontaneously. When the cuff of tracheostomy tube was inflated for assisted manual ventilation and the induction of anesthesia, signs of partial endotracheal obstruction were observed, including high airway pressure, low tidal volume and high ETCO2. Large dried mucous plug was impacted in the tracheostomy tube. After removing this plug with a sterile surgical forcep, effective ventilation was recovered without complications. The case like this nearly fatal obstruction by large dried mucous plug was rarely reported, but it should be considered cautiously when a patient uses tracheostomy tube as an airway before general anesthesia.