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Related Experiment Videos

[Tracheal bleeding during awake fiberoptic intubation].

Tomoharu Tanaka1, Yuki Torii, Hidekatsu Furutani

  • 1Department of Anesthesia, National Hospital Organization Kyoto Medical Center, Kyoto.

Masui. the Japanese Journal of Anesthesiology
|September 20, 2005
PubMed
Summary

Blind nasal fiberoptic intubation in a patient with hypopharyngeal cancer led to tracheal bleeding and difficult ventilation. Emergency tracheostomy was necessary due to airway complications from laryngeal deformity.

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Area of Science:

  • Anesthesiology
  • Otolaryngology
  • Surgical Oncology

Background:

  • Fiberoptic intubation is a common technique for airway management, but carries risks of laryngeal injury.
  • Patients with head and neck cancer often present with complex airway anatomy, increasing intubation challenges.
  • Nasal fiberoptic intubation was chosen for a patient with hypopharyngeal cancer and laryngeal deformity.

Observation:

  • Tracheal bleeding and difficulty with ventilation occurred immediately after tracheal tube insertion.
  • A piece of mucosa and a blood clot were found within the tracheal tube lumen.
  • A hematoma was observed on the surface of the arytenoid cartilage.

Findings:

  • The intubation procedure resulted in significant tracheal bleeding and airway compromise.

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  • The presence of mucosal tissue and blood clot indicated trauma during intubation.
  • The hematoma suggested vascular injury in the laryngeal region.

    • Implications:

    • Careful selection and precise manipulation of the tracheal tube are crucial in patients with complex airways.
    • Pre-procedure availability of surgical airway access is vital for managing potential complications.
    • This case highlights the risks associated with fiberoptic intubation in friable, vascular-rich laryngeal lesions.