Emergency Tracheotomy in an Elderly Patient with Abrupt Airway Obstruction after Oro-maxillofacial Surgery

• Published in: Japanese Journal of Reanimatology Vol. 33; no. 2; pp. 79 - 82
• Main Authors: Shimoda, Hajime, Sato, Minoru
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Reanimatology 25.09.2014; 日本蘇生学会
• Subjects: Cannot ventilate-cannot intubate situations; Emergency tracheotomy; Oro-maxillofacial surgery; Upper airway obstruction; 上気道閉塞; 換気・気管挿管不能; 緊急気管切開; 顎口腔外科手術
• ISSN: 0288-4348; 1884-748X
• DOI: 10.11414/jjreanimatology.33.79

A 76-year-old man diagnosed as having mandibular tumor was anesthetized with N2O-O2-sevoflurane and fentanyl. He underwent partial removal of mandible and mouth floor associated with left upper neck dissection without any eventful episodes. Six hours and half after return to the recovery room, elastic swelling in left submandibular region was objectively recognized. Immediately after he complained of slight respiratory distress with maintenance of spontaneous breathing, an abrupt marked hemorrhagic swelling extending to the entire cervical region and oral cavity brought about apnea due to upper airway obstruction accompanied by severe trismus. Direct laryngoscopic or fiberoptic intubation under vision was judged very difficult and impossible in such a situation. And then prompt emergency tracheotomy with applicable use of fingertip, performed by the first author, resulted in satisfactory restoration to spontaneous breathing and recovery of consciousness, followed by no sign of negative pressure pulmonary edema or secondary neurological impairment caused by airway obstruction. Urgent hemostatic surgical procedures suppressed subsequent swelling around the surgical field.　This case suggests that perioperative upper airway stenosis or obstruction, caused by oral bleeding or jaw deformity, may occur frequently and abruptly in patients undergoing oro-maxillofacial surgery. Consequently, it may be essential for both anesthesiologists and surgeons to master emergency surgical airway manipulation such as percutaneous cricothyroidotomy in patients with“cannot ventilate - cannot intubate”situations.