Tracheal injury detected immediately after median sternotomy by inexperienced surgeons: two case reports

Journal of Medical Case Reports
Jun TakeshitaNobuaki Shime

Abstract

Although median sternotomy is standard during cardiac surgery, the procedure is associated with a risk of injury to mediastinal organs. Here, we discuss two cases of tracheal injury following median sternotomy during cardiac surgery. Ventilation failure occurred in a 78-year-old Japanese man and a 71-year-old Japanese man after median sternotomy, and tracheal injury was identified. The sites of injury were directly repaired and covered with mediastinal fat tissue, following which ventilation was successful. The burn-like deposits observed at the site of tracheal injury and on the removed endotracheal tube support the notion that the injuries in our patients were caused by electrocautery prior to median sternotomy. In one case, short sternotracheal distance may have contributed to tracheal injury during post-sternal manipulation. In both cases, the relative inexperience of both surgeons also supports the suspected cause of injury. Tracheal injury represents a potential complication following median sternotomy, especially when performed by inexperienced surgeons or in cases of short sternotracheal distance. Anesthesiologists should consider this rare yet potentially lethal complication.

References

Feb 1, 1994·Journal of Cardiothoracic and Vascular Anesthesia·M Renna, C Gillbe
May 8, 2001·The Thoracic and Cardiovascular Surgeon·M Meyer
Jul 4, 2001·The Journal of Thoracic and Cardiovascular Surgery·I Takanami
May 29, 2007·The Annals of Thoracic Surgery·Thomas SchneiderHans Hoffmann
Feb 22, 2011·Respiratory Care·Cheng-Yu ChangShih-Chieh Chang
Apr 18, 2012·Annals of Cardiac Anaesthesia·Arindam ChoudhuryUsha Kiran
Aug 8, 2013·Journal of Cardiothoracic and Vascular Anesthesia·Monish RautGulshan Rohra

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Citations

Feb 3, 2019·Seminars in Cardiothoracic and Vascular Anesthesia·Megan D Henley, Priya A Kumar

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Methods Mentioned

BETA
coronary artery bypass
lavage

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