Résumé
It is essential to predict possibility of difficulties beforehand in ventilating or intubating the patient for the safe airway management and anesthetic maintenance. Even if there is no internal invasion, external compression of an enlarged neck mass can cause tracheal stenosis. The patient with nontoxic goitor had symptoms of dysphagia, exertional dyspnea and wheezing. There was difficulty in endotracheal passage of small bronchoscope through the compressed portion of the trachea during preoperative bronchoscopic examination. We premolded an armored endotracheal tube to fit the patient's trachea based on chest radiography, computed tomography and brochoscopic findings. Endotracheal intubation and thyroidectomy was successful and the patient discharged without any complication. We report a new method of intubation in patient with nontoxic goiter that obstructs the trachea by compression.
Sujets)
Humains , Prise en charge des voies aériennes , Bronchoscopes , Troubles de la déglutition , Dyspnée , Goitre , Intubation , Intubation trachéale , Cou , Bruits respiratoires , Thorax , Thyroïdectomie , Trachée , Sténose trachéaleRésumé
We experienced a case of bilateral vocal cord palsy following general anesthesia for craniotomy. The patient was a 43-year-old woman undergoing tumor resection for falx meningioma on frontal lobe. She had no laryngeal symptoms prior to operation. Spontaneous ventilation resumed after reversal of neuromuscular blockade. Following extubation, she showed signs of airway obstruction and dyspnea. Reintubation was done and symptoms improved. Three days after operation, we confirmed bilateral vocal cord palsy by fiberoptic laryngoscopy. We suggested that possible causes of bilateral vocal cord paralysis were hyperflexion of neck and long operating time.