Internet Journal of Airway Management



Volume 6 (January 2010 to December 2011)


Zadrobilek E, Krasser K, Missaghi SM, Puchner W, Trimmel H, Genzwuerker H, Thierbach A, Greif R, Priebe HJ (for the Austrian Working Group for Airway Management). Recommendations of the Austrian Working Group for Airway Management: Airway Management in Patients Developing Hematomas after Neck Surgery

Review of the Current Literature



We found a few case reports (among them: 5, 8), but only one large case series of patients requiring airway management (AM) for surgical evacuation of neck hematomas developing after carotid endarterectomy (21). Of a total of 3.225 patients having undergone carotid endarterectomy at their university hospital between the years 1998 and 2007, the authors identified 44 patients requiring neck exploration for hematoma formation. In two patients, hematoma formation was discovered before tracheal extubation. The other 42 patients had been extubated and required AM immediately before neck exploration. Awake FBA tracheal intubation was primarily attempted in 20 patients and successfully performed in 15 of them. In the five patients with failed awake FBA tracheal intubation, tracheal intubation was successfully performed in all of them by conventional laryngoscopy (CL), in three before and in two after induction of general anesthesia (GA). Tracheal intubation by CL was primarily attempted in 22 patients, in seven patients before and in 15 after induction of GA. Three of the four patients who could not conventionally be intubated during the first attempt were successfully intubated after surgical hematoma decompression. One patient required an emergency tracheotomy. In all patients, initial tracheal intubation had been uneventful. Tracheal intubation was judged to be easy or difficult in 25 and 17 patients, respectively. In this retrospective evaluation, difficulties with face-mask ventilation were not reported, possibly because they were not encountered due to the high preference given to awake tracheal intubation. This report shows that multiple techniques can result in successful airway control both before and after induction of GA, and that emergency tracheotomy is rarely required.



Postoperative Care

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