Résumé
Tracheobronchial rupture due to blunt chest trauma is an uncommon injury and the clinical presentations are variable. Recently, the incidence of tracheobronchial injuries has increased with the increase in traffic accidents and mechanization.The early diagnosis and primary repair of tracheobronchial rupture not only restores normal lung function, but also avoids the difficulties and complications associated with delayed diagnosis and repair.We report our clinical experience in anesthetic management of a patient with complete tracheal transection suffering from progressive dyspnea, subcutaneous emphysema in the neck and anterior chest wall, and bilateral tension pneumothorax.The literature regarding accidental tracheal injuries will be reviewed.
Sujets)
Humains , Accidents de la route , Retard de diagnostic , Dyspnée , Diagnostic précoce , Incidence , Poumon , Cou , Rupture , Stress psychologique , Emphysème sous-cutané , Paroi thoracique , ThoraxRésumé
Patients with complete tracheal transection present a considerable challenge to the anesthesiologist. A 38 year-old woman with complete tracheal transection above the aortic arch level due to blunt trauma was taken to the operating room for an attempt at tracheal repair. Anesthetic management was focused on the maintenance of the airway and adequate ventilation. Primary repair of the trachea was carried out under ventilation support via percutaneous cardiopulmonary support system. Until the disrupted trachea was exposed on the surgical field, ventilation was performed using a laryngeal mask. We discuss the anesthetic management strategies and the alternative mode of ventilation.
Sujets)
Adulte , Femelle , Humains , Aorte thoracique , Masques laryngés , Blocs opératoires , Trachée , VentilationRésumé
Blunt tracheobronchial injuries are rare, and usually lethal without aggressive and appropriate management. Recently, the incidence of tracheobronchial injuries has been increased with the increase of traffic accident and mechanization. We report a case of complete tracheal transection combined with a longitudinal rupture of the membranous portion of the trachea extending to the right main bronchus following blunt chest trauma, and review the anesthetic management.