Various Anaesthetic Techniques used in the Management of Traumatic Diaphragmatic Hernia: A Series of Three Cases

Abstract

Traumatic diaphragmatic hernia is relatively uncommon and occurs most commonly after a road traffic accident (5%). Diaphragmatic rupture is mostly associated with vital organ injuries such as the liver, spleen, lungs, bones, pelvis, and brain, which can be severely damaged. The anaesthetic management of a patient presenting with traumatic diaphragmatic hernia depends on any associated vital organ injuries. Hereby, the author present a case series of three patients with traumatic diaphragmatic hernia with different presentations managed accordingly. In the first case, a 37-year-old male presented with diaphragmatic hernia and cervical spine fracture following a road traffic accident. Awake fibreoptic intubation was performed with utmost care to avoid further injury to the cervical spine. After intubation, positive pressure ventilation was given with low tidal volume to avoid barotrauma and to expand the atelectatic lung. The second case involved a 48-year-old male with a history of falling from a height one week prior, who presented with right-sided diaphragmatic rupture and a liver contusion. Intubation was performed using a left-sided double-lumen tube, and one-lung ventilation was applied to facilitate thoracotomy. A thoracic paravertebral block was administered to alleviate postoperative pain, providing good pain relief. In the third case, a 56-year-old male with a known case of Chronic Obstructive Pulmonary Disease (COPD) presented to the hospital following a road traffic accident. The patient had lung contusion and haemopneumothorax with poor pulmonary reserve, and required emergency surgical repair. Combined spinal-epidural anaesthesia was preferred over general anaesthesia, as intubation may cause bronchospasm and life-threatening complications in COPD patients.

Keywords

• combined spinal-epidural
• double-lumen tube
• fibreoptic intubation
• thoracic paravertebral block