Emergency Tracheal Intubation Using Airwayscope in a Patient with Hematoma after Thyroidectomy

• Published in: Masui. The Japanese journal of anesthesiology Vol. 64; no. 2; p. 185
• Main Authors: Saima, Shunsuke, Asai, Takashi, Endo, Seiko, Okuda, Yasuhisa
• Format: Journal Article
• Language: Japanese
• Published: Japan 01.02.2015
• Subjects: Adult; Airway Management; Emergencies; Female; Hematoma - diagnostic imaging; Hematoma - etiology; Hematoma - surgery; Humans; Intubation, Intratracheal - instrumentation; Intubation, Intratracheal - methods; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Postoperative Complications - surgery; Thyroid Neoplasms - surgery; Thyroidectomy - adverse effects; Tomography, X-Ray Computed
• ISSN: 0021-4892

We report a case of emergency awake intubation using Airwayscope (AWS) in a patient with difficulty of the ventilation combined with severe neck swelling due to hematoma after thyroidectomy. A 28-year-old woman with thyroid tumor received, general anesthesia induced, easily with facemask ventilation and tracheal intubation. Her trachea was extubated after she had become awake. Several minutes later, sudden swelling of the neck was observed, and she lost her consciousness. Despite attempts at facemask ventilation, hypoxia with bradycardia was observed. We judged that insertion of the supraglottic airway or the needle cannulation of the cricothyroid membrane would be difficult reducing the chance of re-intubation. While we asked surgeons to prepare for emergency surgical tracheotomy, we attempted to intubate the trachea using the AWS under sedation. Despite difficulty in opening the mouth and swelling of the tongue, we managed to intubate the trachea. We consider that knowledge of difficult airway management (DAM) is necessary, but we must be flexible to judge which method should be used in each patient In addition we conclude that the AWS is useful for awake intubation.