[Case of perioperative tracheal laceration by electrocautery]

Although tracheal laceration during surgical procedure is a rare complication, it can be life-threating. Its immediate recognition and treatment are important. A 72-year-old man with aortic valve regurgitation was scheduled for aortic valve replacement. At anesthetic induction an endotracheal tube was smoothly inserted and the tidal volume was set at 500 ml with ventilator rate of 12 min-1. After electrocautery maneuver of the upper sterna region, end-tidal carbon-oxide curve suddenly became flat. Immediately after the completion of median sternotomy air bubble was seen in the surgical field. An 8-mm longitudinal tracheal laceration at the fourth tracheal cartilage was identified. The tracheal laceration was repaired with interrupted suture and the mediastinal tissue was used to cover the suture line. Air leaks were no longer present. After surgical repair, the aortic valve replacement was performed. The postoperative courses of both tracheal laceration repair and aortic valve replacement were uneventful.