Airway Management in Penetrating Neck Trauma

Patients with penetrating neck trauma can provide a number of acute and pressing challenges to both the surgeon and anesthesiologist. In this case report, we present a 27 year old man with no significant past medical history... [ view full abstract ]

Patients with penetrating neck trauma can provide a number of acute and pressing challenges to both the surgeon and anesthesiologist. In this case report, we present a 27 year old man with no significant past medical history who presents with a self-inflicted transverse 12 cm suprahyoid neck laceration.  Patient was hemodynamically stable on presentation to the trauma bay with adequate hemostasis secondary to a lack of large vessel involvement, but was agitated and combative and required 300mg of intramuscular ketamine prior to evaluation of the airway. It was unclear at that time whether there was airway involvement so the decision was made to transfer the patient to the operating room for a spontaneously ventilating fiberoptic intubation to facilitate a bronchoscopic examination for ruling out airway injury prior to endotracheal intubation for airway protection.

In the operating room, received 4 mL of atomized 4% lidocaine into the oropharynx before pre-oxygenation.  Patient was given an additional 50mg of intravenous ketamine before gently introducing a GLIDESCOPE size 3 blade into the mouth to initially evaluate for oropharyngeal and laryngeal injury while also stenting the oropharynx open to allow passage of a fiberoptic bronchoscope with a 7.0mm single lumen endotracheal tube loaded onto the back of it.  GLIDESCOPE examination revealed an intact glottis with no clear injury, while fiberoptic examination through the glottis opening and down to the trachea was unremarkable.  Patient was then induced with 200mg of intravenous propofol before the endotracheal tube was passed over the scope and visualized with the tip 3cm above the carina.  Fiberoptic scope was withdrawn and patient received a complex closure with approximation of bilateral suprahyoid muscles.  Patient was extubated on post-operative day 2 without incident.