Ce. Smith et Wf. Fallon, Sevoflurane mask anesthesia for urgent tracheostomy in an uncooperative trauma patient with a difficult airway, CAN J ANAES, 47(3), 2000, pp. 242-245
Citations number
12
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
Purpose: Proper care of the trauma patient often includes tracheal intubati
on to insure adequate ventilation and oxygenation, protect the airway from
aspiration, and facilitate surgery. Airway management can be particularly c
omplex when there are facial bone fractures, head injury and cervical spine
instability.
Clinical Features: A 29-yr-old intoxicated woman suffered a motor vehicle a
ccident. Injuries consisted of multiple abrasions to her head, forehead, an
d face, right temporal lobe hemorrhage, and complex mandibular fractures wi
th displacement. Mouth opening was < 10 mm. Blood pressure was 106/71 mmHg,
pulse 109, respirations 18, temperature 37.3 degrees C, SpO(2) 100%. Chest
and pelvic radiographs were normal and the there was increased anterior an
gulation of C4-C5 on the cervical spine film. Drug screen was positive for
cocaine and alcohol. The initial plan was to perform awake tracheostomy wit
h local anesthesia, However, the patient was uncooperative despite sedation
and infiltration of local anesthesia. Sevoflurane, 1%, inspired in oxygen
100%, was administered via face mask. The concentration of sevoflurane was
gradually increased to 4%, and loss of consciousness occurred within one mi
nute. The patient breathed spontaneously and required gentle chin lift and
jaw thrust. A cuffed tracheostomy tube was surgically inserted without comp
lication. Blood gas showed pH 7.40, PCO2 35 mmHg, PO2 396 mmHg, hematocrit
33.6%. Diagnostic peritoneal lavage was negative. Pulmonary aspiration did
not occur. Oxygenation and ventilation were maintained throughout the proce
dure.
Conclusion: Continuous mask Ventilation with sevoflurane is an appropriate
technique when confronted with an uncooperative trauma patient with a diffi
cult airway.