Airway management in a case of expanding neck hematoma after carotid endarterectomy
Background: Respiratory obstruction is a fatal complication following carotid endarterectomy, which caused direct compression of trachea secondary to venous and lymphatic congestion.
Cases Report: In this study, we report a complicated case of carotid endarterectomy that required emergency intubation in difficult circumstance due to progressing hematoma and soft tissue edema.
Conclusion: we report a case of hematoma and edema causing compromised airway following carotid endarterectomy (CEA), in which quick action to decompress the hematoma and prepare a secure airway lead to successful outcome.
Brott TG, Hobson RW, II, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010; 2013:11–23.
Taha MM, Sakaida H, Asakura F, et al. Access site complications with carotid angioplasty and stenting. Surg Neurol. 2007;2013:431–7.
McDonald RJ, Cloft HJ, Kallmes DF. Intracranial hemorrhage is much more common after carotid stenting than after endarterectomy: evidence from the National Inpatient Sample. Stroke. 2011;2013:2782–7.
Self DD, Bryson GL, Sullivan PJ. Risk factors for post-carotid endarterectomy hematoma formationCan J Anesth. 1999;46:635e40.
R.E. Welling, H.S. Ramadas, K.J. Gansmuller. Cervical wound hematoma after carotid endarterectomy. Ann Vasc Surg. 1989;3:229e31.
Baracchini C, Gruppo M, Mazzalai F. Predictors of neck bleeding after carotid endarterectomy. J Vasc Surg, 2011; 54:699e705.
J. Smout, G. Stansby. Current practice in the use of antiplatelet agents in the peri-operative period by UK vascular surgeons. Ann R Coll Surg Engl. 2003;85:97-101.
A.J. Jackson, R.P. Teenan, D.J. Orr. The use of clopidogrel in carotid endarterectomy: an audit of current practice. Eur J Vasc Endovasc Surg. 2007;34:312-3.
Hamish M, Gohel MS, Shepherd A, Howes NJ, Davies AH. Variations in the pharmacological management of patients treated with carotid endarterectomy: a survey of European vascular surgeons Eur J Vasc Endovasc Surg. 2009;38::402-7.
C. COX, J. BANNISTER. Anesthesia for carotid artery surgery. British journal of anesthesia.1994;74:252.
Self DD, Bryson GL, Sullivan PJ. Risk factors for post-carotid endarterectomy hematoma formation. Can J Anaesth 1999; 46:635–40.
Boyce JR, Peters GE. Complete vasomotor collapse: an unusual manifestation of the carotid sinus reflex. Anesthesiology 2003;98:1285-7.
Sethi R, Tandon MS, Ganjoo P. Neck hematoma causing acute airway and hemodynamic compromise after anterior cervical spine surgery. J Neurosurg Anesthesiol. 2008;20:69-70.
Yu NH, Jahng TA, Kim CH. Life threatening late hemorrhage due to superior thyroid artery dissection after anterior cervical discectomy and fusion. Spine. 2010;35:739-42
O'Sullivan JC, Wells DG, Wells GR. Difficult airway management with neck swelling after carotid endarterectomy. Anaesth Intensive Care. 1986;14(4):460-4.