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Dramatischer Atemwegsnotfall nach Operation an der Halswirbelsäule

Retrospektive Analyse der Fehlerkette

Severe airway distress following cervical spine operation

Retrospective breakdown of the chain of errors

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Zusammenfassung

Einer 71-jährigen Patientin wurde aufgrund eines zervikalen Bandscheibenprolapses eine Prothese implantiert. Postoperativ trat eine Einblutung in die kollaren Weichteile auf. Nach erfolgter Computertomographie- (CT-)Diagnostik kam es bei der Rachenanästhesie für die fiberoptische Reintubation zur perakuten respiratorischen Dekompensation. Die Patientin konnte konventionell laryngoskopisch nicht intubiert werden, worauf eine Notfallkoniotomie indiziert wurde. Da ein industrielles Set nicht zeitnah beigebracht werden konnte, wurde der Atemweg durch eine offen-chirurgische Koniotomie etabliert. Kommt es nach Halswirbelsäulen- (HWS-)Operation zur Trias Dyspnoe, Dysphonie und Dysphagie, sollte umgehend eine Atemwegssicherung nach lokal üblichem Algorithmus erfolgen.

Abstract

A 71-year-old female patient received a prothesis due to a cervical disc prolapsed and bleeding into the collar soft tissues occurred postoperatively. Following a computed tomography examination severe peracute respiratory decompensation occurred while administering topical anesthesia to the pharynx in order to perform fiber optic intubation. Endotracheal intubation using conventional laryngoscopy was unsuccessful and the patient required immediate cricothyroidotomy. As an on-site cricothyrotomy set to establish a secure airway was not available the decision was taken to perform surgical cricothyroidotomy. As a conclusion to this life-threatening event in the case of symptoms, such as dyspnea, dysphonia and dysphagia after operations of the cervical spine the airway has to be secured early and according to the local algorithm.

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Authors and Affiliations

  1. Institut für Notfallmedizin, Berufsfeuerwehr Stadt Köln, Scheibenstr. 13, 50737, Köln, Deutschland

    C. Paul

  2. Abteilung für Anästhesiologie, Marien-Hospital, Erftstadt, Deutschland

    A. Ladra

  3. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinik Köln, Köln, Deutschland

    V. Pillai, B.W. Böttiger & F. Spöhr

  4. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln, Köln, Deutschland

    K. Keller & K. Zarghooni

Authors
  1. C. Paul
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  2. A. Ladra
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  3. V. Pillai
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  4. B.W. Böttiger
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  5. F. Spöhr
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  6. K. Keller
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  7. K. Zarghooni
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Correspondence to C. Paul.

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Paul, C., Ladra, A., Pillai, V. et al. Dramatischer Atemwegsnotfall nach Operation an der Halswirbelsäule. Anaesthesist 60, 845–849 (2011). https://doi.org/10.1007/s00101-011-1914-z

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  • DOI: https://doi.org/10.1007/s00101-011-1914-z

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