Anesthetic Management of 50-Year-Old Male Patient with Pan-Facial Trauma: Challenges and Considerations
Abstract
Pan facial trauma, involving multiple fractures of the facial bones, presents significant challenges in anaesthetic management. These injuries often result from high-impact accidents and can lead to airway compromise, making intubation and ventilation difficult. The anaesthesiologist must navigate potential obstacles such as facial distortion, bleeding, and limited mouth opening, all while maintaining cervical spine precautions. The management of these cases requires a thorough preoperative assessment, careful planning, and often necessitates advanced airway techniques. This case report describes the anaesthetic management of a 50-year-old male patient with pan facial trauma scheduled for reconstructive surgery. It highlights the use of CMAC video laryngoscopy intubation as a safe and effective technique in securing the airway in a patient with anticipated difficult intubation. The report also discusses the rationale behind the anaesthetic choices made and the perioperative challenges encountered. By sharing this experience, we aim to contribute to the existing body of knowledge on managing complex airway scenarios in trauma patients and emphasize the importance of individualized anaesthetic planning in such cases.
[2] Kellman RM, Losquadro WD. Comprehensive airway management of patients with maxillofacial trauma. Craniomaxillofac Trauma Reconstr. 2008;1(1):39-47.
[3] Krausz AA, El-Naaj IA, Barak M. Maxillofacial trauma patient: coping with the difficult airway. World J Emerg Surg. 2009;4:21.
[4] Law JA, Broemling N, Cooper RM, Drolet P, Duggan LV, Griesdale DE, et al. The difficult airway with recommendations for management--part 1--difficult tracheal intubation encountered in an unconscious/induced patient. Can J Anaesth. 2013;60(11):1089-118.
[5] Mosier JM, Joshi R, Hypes C, Pacheco G, Valenzuela T, Sakles JC. The Physiologically Difficult Airway. West J Emerg Med. 2015; 16(7):1109-17.
[6] Hernández Altemir F. The submental route for endotracheal intubation. A new technique. J Maxillofac Surg. 1986;14(1):64-5.
[7] Oshima N, Shiraishi T, Kawauchi T, Oba J, Sato D, Fujiki M, et al. A Simple and Reliable Submental Intubation Technique for Maxillofacial Fractures. J Craniofac Surg. 2018; 29(7):1952-1955.
[8] Woods BD, Sladen RN. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009;103 Suppl 1:i57-65.
[9] Hirota K, Sato T, Hashimoto Y, Hashiba E, Kudo T, Ishihara H, et al. Relaxant effect of propofol on the airway in dogs. Br J Anaesth. 1999; 83(2):292-5.
[10] Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014; 35(35):2383-431.
[11] Pedersen CM, Rosendahl-Nielsen M, Hjermind J, Egerod I. Endotracheal suctioning of the adult intubated patient--what is the evidence? Intensive Crit Care Nurs. 2009; 25(1):21-30.
[12] Cavallone LF, Vannucci A. Review article: Extubation of the difficult airway and extubation failure. Anesth Analg. 2013; 116(2):368-83.
[13] Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997;112(1):186-92.
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Section | Case Report(s) | |
Keywords | ||
pan facial trauma submental intubation CMAC challenges anaesthesiologist |
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