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KMID : 1235920090010010110
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Medical Journal of Catholoc University of Daegu
2009 Volume.1 No. 1 p.110 ~ p.113
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The Airway Management of a Patient with the Impaled Neck for General Anesthesia - A Case Report -
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Song Seok-Young
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Abstract
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In the patient impaled with foreign body from chin through face, it could be difficult to manage the airway in classic mothod with laryngoscope for general anesthesia. Construction rebar lodged in the bottom right under the chin from a fall over it and passed through the top-right across the cheek of victims. Pain, psychiatric trauma and the uncertainty of securing airway made the supine position impossible that the CT or MRI scan was unavailable. We planned to perform the surgical tracheostomy under local infiltration if we would fail to intubate endotracheal tube with fiberoptic bronchoscope on the sitting position under awake state. On the sitting position, we sprayed over only the nasal cavity and oropharynx with 10% xylocaine 5 minutes after bosmin nasal packing. The transcricothyroid membrane infiltraition with lidocaine was not performed. Reinforced endotracheal tube (ID 6.0 mm, Safety-flex, Mallinckrodt, Athlone, Ireland) was used with sufficient lubricant to ease to pass through the vocal cord. Low dose of remifentanil was continuously infused intravenously for sedation under monitoring his consciousness and oxygen saturation. The procedure for intubation was performed in the front of sitting patient facing. In this case, we could manage successfully the general anesthesia through the awake intubation with transnasal fiberoptic bronchoscope in the sitting position under thr sedation with continuous intravenous remifentanil infusion.
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KEYWORD
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Difficult airway management, Fiberoptic bronchoscope, Impaled, Remifentanil
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