Percutaneous dilatational tracheostomy in a patient with a large midline aberrant artery.

IF 3.4 3区 医学 Q1 ANESTHESIOLOGY
Balaji Vaithialingam, Abinash Dutta, Swaroop Gopal
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引用次数: 0

Abstract

Purpose: A midline aberrant artery is an absolute contraindication to percutaneous dilatational tracheostomy (PDT). In this case report, we highlight a number of technical modifications that resulted in a successful PDT in a patient with a large midline aberrant artery.

Clinical features: A 72-yr-old woman with a posterior cranial fossa hematoma underwent PDT due to prolonged mechanical ventilation in the neurointensive care unit. On clinical examination, the patient had a huge, pulsatile midline neck mass. Ultrasonography (US) showed an aberrant artery that covered the entire tracheal length and deviated to the right, away from the midline, just below the cricoid cartilage at the level of the first tracheal ring. The patient's family members were counseled, and following provision of informed consent, we planned PDT with technical modifications. After anesthesia induction, we replaced the endotracheal tube with a supraglottic airway device. We performed surface marking with US and chose a higher entry point between the first and second tracheal rings with a left anterolateral approach to the trachea. We made a 1-cm skin incision away from the midline towards the left side to aid with dilatation during the PDT procedure. We punctured the left anterolateral tracheal wall under real-time fibreoptic bronchoscopy and successfully performed PDT using a single-dilatation Ciaglia technique.

Conclusion: This report provides an anecdotal description of successful PDT in a patient with a large midline aberrant artery based on the use of US and a number of technical modifications. Nevertheless, PDT should continue to be considered contraindicated in patients with a midline aberrant artery, in whom surgical tracheostomy is the recommended technique.

经皮扩张气管切开术治疗大中线异常动脉1例。
目的:中线异常动脉是经皮扩张性气管切开术的绝对禁忌症。在这个病例报告中,我们强调了一些技术改进,这些技术改进导致了一个大中线异常动脉患者的PDT成功。临床特征:一名72岁女性颅后窝血肿患者因长时间机械通气在神经重症监护室接受PDT治疗。临床检查发现患者颈部中线有一个巨大的搏动性肿块。超声(US)显示异常动脉覆盖整个气管长度并向右偏离中线,位于第一气管环环状软骨下方。告知患者家属,在提供知情同意后,我们计划对PDT进行技术修改。麻醉诱导后,我们用声门上气道装置替换气管内管。我们用US进行了表面标记,并在第一和第二气管环之间选择了一个较高的入口点,采用左前外侧入路进入气管。在PDT手术过程中,我们从中线向左侧做了一个1厘米的皮肤切口,以帮助扩张。我们在实时纤维支气管镜下穿刺左前外侧气管壁,并成功地使用单次扩张Ciaglia技术进行PDT。结论:本报告提供了一个轶事描述,在使用US和一些技术修改的基础上,成功的PDT患者有一个大的中线异常动脉。尽管如此,对于中线异常动脉的患者,PDT仍被认为是禁忌,在这种情况下,气管切开术是推荐的技术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.50
自引率
7.10%
发文量
161
审稿时长
6-12 weeks
期刊介绍: The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.
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