Article

Airway management in patients who develop neck hematomas after carotid endarterectomy.

Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55902, USA.
Anesthesia and analgesia (Impact Factor: 3.08). 12/2009; 110(2):588-93. DOI: 10.1213/ANE.0b013e3181c85128
Source: PubMed

ABSTRACT Progressive airway compromise from neck hematoma and edema is a feared complication of carotid endarterectomy (CEA). Despite this, the relationship of airway management technique to patient outcome has not been systematically studied in this population. We report the rate of successful airway management using various techniques in post-CEA patients.
A 10-year retrospective analysis was conducted to identify patients requiring airway management for neck exploration within 72 hours after CEA at Mayo Clinic, Rochester, MN.
Three thousand two hundred twenty-five patients underwent CEA over a 10-year period at our institution. Forty-four (1.4%) required neck exploration for hematoma, and 42 of these required airway management immediately before neck exploration surgery. (The tracheal tube had not been removed after CEA in the remaining 2 patients.) The average interval between the completion of CEA and return to the operating room for hematoma evacuation was 6.0 +/- 6.0 hours (mean +/- SD; range, <1-32 hours). Fiberoptic airway management, performed before the induction of anesthesia, was successful in 15 of 20 patients (75%) and, in patients in whom fiberoptic tracheal intubation failed, direct laryngoscopy (DL) was successful in all 5 (3 before and 2 after the induction of general anesthesia). In the remaining 22 patients, DL was used as the initial management technique without a trial of fiberoptic intubation. DL was successful in 5 of 7 patients (71%) when performed before induction of general anesthesia and was successful in 13 of 15 patients (87%) when performed after induction of general anesthesia. Hematoma decompression facilitated DL in 3 of 4 failures of DL; tracheostomy was performed in the remaining patient. An arterial site of bleeding was subsequently identified in 36% of patients in whom no difficulty was encountered during laryngoscopy for hematoma evacuation versus 6% in whom difficulty was noted (P = 0.03). In 36 of 44 patients (82%), the tracheal tube was removed within 24 hours of surgery for neck exploration. No adverse events related to airway management were noted. There were no deaths at 2 weeks after hematoma evacuation.
Multiple techniques resulted in successful airway control both before and after the induction of general anesthesia. Tracheal intubation was accomplished with both fiberoptic visualization and DL. In instances of poor direct visualization of the glottis, decompression of the airway by opening of the surgical incision may facilitate intubation of the trachea.

0 Bookmarks
 · 
350 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We provide a summary of the 2010 literature pertinent to the care of neurosurgical patients and those requiring neurocritical care. In addition, we address topics in the basic neurosciences as they relate to neuroanesthesiology. This review incorporates studies not only from both neuroanesthesiology and general anesthesiology-focused journals, but also from neurology, neurosurgery, critical care, and internal medicine journals and includes articles published after January 1, 2010, through those available on-line by November 31, 2010. We will review the broad categories of general neuroanesthesiology, with particular emphasis on cerebral physiology and pharmacology, intracranial hemorrhage, carotid artery disease, spine surgery, traumatic brain injury, neuroprotection, and neurotoxicity. When selecting articles for inclusion in this review, we gave priority to those publications that had: (1) new or novel information, (2) clinical utility, (3) a study design possessing appropriate statistical power, and/or (4) meaningful, unambiguous conclusions.
    Journal of neurosurgical anesthesiology 04/2011; 23(2):67-99. · 2.41 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: One of the most serious adverse events associated with anterior cervical spine surgery is wound hematoma resulting in airway compromise. The reported incidence of this postoperative complication has varied from 0.2% to 1.9%. Obstruction of the airway secondary to bleeding presents a challenging clinical scenario given the rapidity of onset, distorted anatomy of the upper respiratory tract, urgent need to act and potential for catastrophic consequences. This high-risk, life-threatening clinical scenario requires specialized knowledge and a well-designed treatment protocol to achieve a positive outcome. In this review, we report a case of airway compromise secondary to wound hematoma following anterior cervical discectomy and fusion, followed by a review of relevant literature, anatomy, etiologic factors and diagnostic considerations. We also propose guidelines for the prevention and management of postoperative airway obstruction due to wound hematoma.
    The Open Orthopaedics Journal 01/2012; 6:108-13.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Traumatic rupture of the thyroid gland is rare. A common approach does not exist. Surgical and nonsurgical management have been advocated.
    Wiener medizinische Wochenschrift (1946). 05/2014;

Full-text

View
17 Downloads
Available from