Pseudomeningocele: An unusual cause of intraoperative tracheal compression and expiratory obstruction

Department of Anesthesiology, University of Virginia Health System, P.O. Box 800710, Charlottesville, VA 22908-0710, USA.
Anesthesia and analgesia (Impact Factor: 3.47). 07/2008; 107(1):226-8. DOI: 10.1213/ane.0b013e3181770a45
Source: PubMed


Cerebrospinal fluid leak resulting from spine surgery has been associated with postoperative upper airway obstruction and the need for emergent airway management. We report a case of a known pseudomeningocele resulting in acute intraoperative compression of the intrathoracic trachea and an unexpected variable expiratory obstruction.

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    • "However, there is a case that adult male patient had severe tracheal obstruction due to the pseudomeningocele after induction of general anesthesia. Thus we assumed that the airway obstruction in our patient was caused by external compression by blood vessels [10]. In this case, the blood vessel does not encircle the trachea like a ring and the innominate artery is branched in the normal location of aortic arch. "
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    ABSTRACT: Tracheal compression by vascular anomalies in adults is uncommon and most related reports are of children. A 79-year-old woman without any respiratory history underwent a lumbar spine surgery under general anesthesia. She suddenly developed airway obstruction after a position change from supine to prone. A fiberoptic bronchoscopy showed the obstruction of endotracheal tube. The obstruction was relieved after we changed the depth of endotracheal tube and supported the patient's neck with a cotton roll. The surgery ended without any other event and the patient recovered safely. A computed tomography revealed the rightward tracheal deviation and tortuous innominate artery contact with trachea. The patient didn't manifest any respiratory related symptoms during postoperative period, and she was discharged without any treatment.
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