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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2006 December;72(12):1007-12
language: English, Italian
Tracheal rupture after tracheal intubation: effectiveness of conservative treatment
Moschini V., Losappio S., Dabrowska D., Iorno V.
Fondazione IRCCS Policlinico Mangiagalli Regina Elena, Milan, Italy
A tracheal rupture is a rare complication of tracheal intubation. Risk factors include advanced age, COBP and corticosteroid therapy. The direct causes of the rupture are difficult tracheal intubation, particularly with a stylet inside the tube and overdistension of the cuff of the tracheal tube. The case of a 73-year-old woman with a tracheal rupture after an uncomplicated operation of a vaginal hysterectomy and bilateral adenexectomy is reported. The procedure of orotracheal intubation presented no difficulties. However, after 5 h the patient was presenting unexpected symptoms such as dyspnea and subcutaneous emphysema. After an inconclusive chest X-ray and chest TC, the diagnosis was made by emergency fiberendoscopy. We adopted a conservative treatment, consisting of a tracheal intubation and chest drain, which resulted in a full recovery after 5 days of mechanical ventilation. The causes that could have provoked a tracheal laceration in our patient and the suggested therapies with preference for conservative treatment, are discussed. We recommend a tracheal tube cuff monitoring during surgery, to prevent fatal overinflaton of the cuff, which is permeable to nitrous oxide.