Anesthetic Management for Emergent Repair of Tracheoinnominate Fistula

We present a case of a 30-year-old female, who had tracheostomy revision complicated by false passage into the subcutaneous space and pneumothorax. Six days later, she developed massive bleeding from the mouth, nose, and tracheostomy site. Approximately 2 liters of blood was lost. With high suspicio...

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Bibliographic Details
Published in:Case reports in anesthesiology 2020, Vol.2020 (2020), p.1-4
Main Authors: Nadar, Vinayak, Banik, Ratan K.
Format: Article
Language:English
Subjects:
Bronchoscopy
Case Report
Case reports
Catheters
Chest tubes
Defects
Fistula
Hemorrhage
Hepatitis
Intubation
Liver diseases
Mortality
Ostomy
Pneumothorax
Surgeons
Surgery
Thrombocytopenia
Tracheostomy
Tracheotomy
Veins & arteries
Ventilators
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Summary:We present a case of a 30-year-old female, who had tracheostomy revision complicated by false passage into the subcutaneous space and pneumothorax. Six days later, she developed massive bleeding from the mouth, nose, and tracheostomy site. Approximately 2 liters of blood was lost. With high suspicion for tracheo-innominate fistula, she was emergently brought to the operating room for fistula repair. Her anesthetic management was initially focused on maintaining spontaneous ventilation with inhalation agents until surgical exposure was adequate. An endotracheal tube was then placed under guidance of a video-laryngoscope. The tracheostomy tube was then removed over a Cook catheter to maintain secure passage in case of airway collapse. The oral endotracheal tube was then inserted distal to the arterial and tracheal defect. The patient’s bleeding was stopped, the fistula was repaired, and she was transferred back to the intensive care unit, but she died several days later due to multi-organ failure.
ISSN:2090-6382
2090-6390
DOI:10.1155/2020/8865303