Delayed diagnosis of postintubation tracheal laceration in a patient who underwent septorhinoplasty including osteotomy: A case report

Iatrogenic postintubation tracheal injury is a rare but potentially fatal complication associated with anesthesia. However, as signs of tracheal injury including subcutaneous emphysema, pneumomediastinum, pneumothorax, and respiratory distress may also be related to surgical technique, diagnosis may be confused and treatment of tracheal injury can be delayed. We report a case of postintubation tracheal laceration, whose diagnosis was delayed because of symptoms were confused with subcutaneous emphysema after septorhinoplasty including osteotomy. As symptoms deteriorated in spite of conventional management, patient underwent evaluation to determine other causes and eventually postintubation tracheal injury was detected. Therefore, even if there is no problem during tracheal intubation, it is necessary to consider postintubation tracheal injury in patients with subcutaneous emphysema that worsens despite appropriate treatment after septorhinoplasty including osteotomy.

Tracheal laceration found after endotracheal general anesthesia : A case report

Tracheal laceration is a rare complication after endotracheal intubation with an estimated incidence of 1:10,000. We present a case of tracheal laceration after general anesthesia with endotracheal intubation. A 63-year-old woman underwent ureteroscopic stone removal under the general anesthesia. She had history of treatment for hypertension and DM for 10 years. Surgery, anesthesia and recovery phase were uneventful. Postoperative first day, patient complained chest discomfort and chest radiography showed the clinical diagnosis of marked subcutaneous emphysema and pneumomediastinum. Postoperative second day, chest CT scan revealed laceration of the posterior tracheal wall extending from the middle of the trachea to the level of 5 cm above carina. Surgical repair was done. We review risk factors, diagnosis and principles of treatment of this lesion.

Tracheal laceration detected by high end-tidal CO2 during endoscopic thyroidectomy / 대한마취과학회지

Endoscopic thyroidectomy is frequently used for cosmetic reasons, such as reducing cervical scarring. Subcutaneous gas insufflation with CO2 is needed to maintain the surgical space, and optimal surgical techniques and careful attention are required when conducting this procedure due to the limited space available for the endoscopic instruments. We report here a case of a tracheal laceration with a tear in the cuff of a reinforced tube, which was detected by an abrupt increase in end-tidal CO2 to 90 mmHg. Reintubation was achieved using a tube exchanger and the patient was effectively ventilated without complications.

Airway Obstruction by Swelling of Inner Wall of Armored Tube and Tracheal Laceration during Endoscopic Thyroidectomy: A case report / 대한마취과학회지

Recently, an endoscopic approach has been preferred for a thyroidectomy due to cosmetic considerations and the shortening of the hospital stay. An endotracheal tube may become obstructed by bending or compression due to changes in patient's position in the preperation for head and neck surgery. Therefore, the use of an armored tube has been increasing for this type of surgery. A new armored tube obstruction was experienced in a 27-years-old female patient with a thyroid adenoma, who underwent an endoscopic thyroidectomy. The swelling of a layer of the inner wall of the new armored tube was detected at about 10 cm, which caused an obstruction of 50% of the radius of the tube. Tracheal laceration also occurred during the operation, which was sutured under endoscopy; however, the stitches became unknotted in the recovery room, but were corrected by exploration.