Immediate postoperative airway obstruction secondary to airway edema following tumor excision from the neck.

Journal of Anesthesia
Goneppanavar UmeshGurudas Kini

Abstract

A 46-year-old woman was scheduled for excision of a malignant peripheral nerve sheath tumor from the neck. The tumor had caused deviation of the trachea to the left and partial obstruction of the superior vena cava. Her upper airway at laryngoscopy after induction of anesthesia was normal. During tumor resection there were transient phases characterized by the complete disappearance of the peripheral oxygen saturation (Sp(O2)) and radial artery tracings. At the end of the operation, the trachea was extubated after ensuring adequate antagonization of neuromuscular blockade. However, immediately post-extubation, she showed signs of acute airway obstruction that necessitated reintubation of the trachea. Laryngoscopy revealed significant edema of the upper airway and vocal cords, requiring a smaller size tracheal tube. Many reports suggest the development of significant airway edema 24 h after such surgery. Our report highlights the fact that this can happen in the immediate postoperative period also. Some authors suggest that, in such surgery, extubation should routinely be done over pediatric tube exchangers. Routine leak testing and direct laryngoscopic/fiberoptic evaluation of the upper airway prior to extubation may also help....Continue Reading

References

Jan 1, 1992·Anaesthesia·M M Fisher, R F Raper
May 1, 1982·Anaesthesia·M D Bexton, R Radford
Jun 10, 1998·Anaesthesia and Intensive Care·A Penberthy, N Roberts
May 25, 1999·The American Journal of Emergency Medicine·S P Roy
Jun 29, 2005·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Christopher M BurkleSteven H Rose
Dec 22, 2005·Anesthesia and Analgesia·Christopher M BurkleJan L Kasperbauer

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