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Anaesthetic management of a patient with complete tracheal rupture following blunt chest trauma


1 Departments of Anaesthesiology, Perioperative Medicine and Pain, Apollo Gleneagles Hospitals, Kolkata, India
2 Department of Critical Care Medicine, Apollo Gleneagles Hospitals, Kolkata, India
3 Department of Surgery, Apollo Gleneagles Hospitals, Kolkata, India

Correspondence Address:
Saikat Sengupta
Flat 402, Binayak Residency, 6/5D Anil Maitra RD, Kolkata - 700 019
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.41582

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Year : 2008  |  Volume : 11  |  Issue : 2  |  Page : 123-126

 

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Complete tracheal resection is extremely rare after blunt chest trauma. A high degree of suspicion is essential to identify these cases and early intervention is associated with better outcome. We report a patient with complete tracheal resection, in whom the airway was secured whilst the patient remained awake, breathing spontaneously under fibreoptic bronchoscopic guidance. As a precautionary measure, we had kept cardiopulmonary bypass set up in readiness. Anaesthetic management needed to be modified during repair of the trachea, by using total intravenous anaesthesia with propofol and rocuronium infusion and insertion of a separate endotracheal tube into the distal portion of the trachea whilst reconstruction of the trachea took place. The usual inhalational technique could not be used. The anaesthesiologist managing such a case should be aware of the difficulties during securing the airway and during repair of the trachea. Proper planning and keeping back-up plans ready helps in successful management of these patients.






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1 Departments of Anaesthesiology, Perioperative Medicine and Pain, Apollo Gleneagles Hospitals, Kolkata, India
2 Department of Critical Care Medicine, Apollo Gleneagles Hospitals, Kolkata, India
3 Department of Surgery, Apollo Gleneagles Hospitals, Kolkata, India

Correspondence Address:
Saikat Sengupta
Flat 402, Binayak Residency, 6/5D Anil Maitra RD, Kolkata - 700 019
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.41582

Rights and Permissions

Complete tracheal resection is extremely rare after blunt chest trauma. A high degree of suspicion is essential to identify these cases and early intervention is associated with better outcome. We report a patient with complete tracheal resection, in whom the airway was secured whilst the patient remained awake, breathing spontaneously under fibreoptic bronchoscopic guidance. As a precautionary measure, we had kept cardiopulmonary bypass set up in readiness. Anaesthetic management needed to be modified during repair of the trachea, by using total intravenous anaesthesia with propofol and rocuronium infusion and insertion of a separate endotracheal tube into the distal portion of the trachea whilst reconstruction of the trachea took place. The usual inhalational technique could not be used. The anaesthesiologist managing such a case should be aware of the difficulties during securing the airway and during repair of the trachea. Proper planning and keeping back-up plans ready helps in successful management of these patients.






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