Tracheal laceration following intubation with a C-MAC® videolaryngoscope. Case Report

Abstract

Introduction: Post-intubation tracheal laceration is a complication with a low incidence, but due to its clinical relevance and high mortality risk, it must be suspected in cases of endotracheal intubation. Case presentation: A 74-year-old woman with a history of high blood pressure and mitral and tricuspid insufficiency underwent a laparoscopic cholecystectomy under general anesthesia in a tertiary care hospital in Zaragoza, Spain, a procedure in which a C-MAC® videolaryngoscope was used to perform the intubation. The patient, 20 minutes after extubation, presented hemoptysis, dyspnea and a decrease in oxygen saturation, so a fibrobronchoscopy was performed and a 1.5 cm bleeding tracheal laceration was observed. Intravenous antibiotic treatment was started, and chest X-ray and computed axial tomography ruled out serious complications such as pneumothorax, pneumomediastinum, or tracheal rupture. During the observation period, the patient had a normal blood oxygen level and remained hemodynamically stable. She was discharged after 72 hours. Conclusions: Since tracheal lacerations are associated with high mortality rates, a high index of clinical suspicion is required, particularly in patients with risk factors for this type of injury in difficult intubation cases, in order to avoid the delay of timely diagnostic and therapeutic measures, thus decreasing possible complications and improving prognosis. Furthermore, these injuries require individualized treatment by a multidisciplinary team.

Keywords

• Intubation
• Hemoptysis
• Dyspnea
• Bronchoscopy
• Case Reports