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Thoracic Anesthesia and Cross Field Ventilation for Tracheobronchial Injuries: A Challenge for Anesthesiologists

DOI: 10.1155/2014/972762

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Tracheobronchial injuries are rare but life threatening sequel of blunt chest trauma. Due to the difficult nature of these injuries and the demanding attributes of the involved surgery, the anesthesiologist faces tough challenges while securing the airway, controlling oxygenation, undertaking one-lung ventilation, maintaining anesthesia during tracheal reconstruction, and gaining adequate postoperative pain control. Amongst the few techniques that can be used with tracheobronchial injuries, cross field ventilation is a remotely described and rarely used technique, especially in injuries around the carina. We effectively applied cross field ventilation in both our cases and the outcome was excellent. 1. Introduction Tracheobronchial injuries (TBI) are life threatening complications encountered in blunt chest and neck trauma. Tracheal injuries should be suspected in all patients involved in high speed motor vehicle accidents. The first successful repair of a bronchial rupture caused by blunt chest trauma was reported in 1947 by Kinsella and Johnsrud [1]. They are found in 0.8% of blunt thoracic trauma victims presenting for emergency surgery [2]. Tragically, 30% to 80% of these patients die before reaching the hospital [3]. Surgical repair remains the treatment of choice for such injuries. Due to the difficult nature of these surgeries, the anesthesiologist faces tough challenges securing the airway, controlling oxygenation and ventilation, undertaking one-lung ventilation, maintaining anesthesia during tracheal reconstruction with loss of ventilation to the atmosphere, and gaining adequate postoperative pain control. For appropriate management of these injuries in the operating room, modified anesthetic techniques and effective communication with the thoracic surgeon are important. Key considerations are avoidance of excessive preoperative sedation, maintaining spontaneous ventilation during intubation, using bronchoscopy to visualize and secure the airway, avoiding blind instrumentation [4, 5], single-lumen tube endobronchial intubation, cross field ventilation, and adequate postoperative pain control. Using these techniques, the outcome of our cases was excellent. In the current case scenario, we shall discuss anesthetic management of two patients who presented to our level-1 trauma center, between years 2010 and 2012, with tracheobronchial injuries following severe blunt chest trauma in motor vehicle accidents. 2. Case Report Number 1 A 20-year-old male presented following a motor vehicle accident. His physical findings included a right-sided tension

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