Der Anaesthesist

, Volume 55, Issue 1, pp 45–52 | Cite as

Die Perforation des Hypopharynx als seltene, lebensbedrohliche Komplikation der endotrachealen Intubation

Kasuistiken

Zusammenfassung

Hintergrund

Die endotracheale Intubation gilt als „golden standard“ bei der Atemwegssicherung mit geringer Komplikationsrate. Perforierende Verletzungen des Atem- und Speiseweges zählen hierbei zu den seltenen schwer wiegenden Komplikationen.

Material und Methode

Es werden zwei Fälle einer Hypopharynxperforation als Komplikation nach elektiver Intubationsnarkose im Vergleich zur Literatur vorgestellt.

Ergebnisse

Während bei einer Patientin die Intubation als erschwert eingeschätzt wurde, war die zweite Patientin ohne Risikofaktoren. Die erste Patientin entwickelte das typische klinische Bild am ersten postoperativen Tag. Die andere Patientin zeigte zunächst eine geringe klinische Symptomatik. Erst zunehmende Schluckbeschwerden im Verlauf führten zur Diagnose eines ausgedehnten retropharyngealen Abszesses. Als Folge entwickelte sich ein Atemnotzustand, der einen primär invasiven Atemwegszugang erforderte. In beiden Fällen führte die chirurgische Intervention in Kombination mit einer antibiotischen Therapie zur folgenlosen Abheilung.

Schlussfolgerungen

Ärzte, die endotracheal intubieren oder Patienten nach einer Intubation behandeln, sollten das klinische Bild einer Perforation des Hypopharynx kennen. Nur so sind eine frühzeitige Diagnostik und Therapie vor der Ausbildung einer manifesten Mediastinitis möglich. Bei drohender „Cannot-intubate-cannot-ventilate-Situation“ hat ein weitlumiger transtrachealer Atemwegszugang unter Lokalanästhesie und Spontanatmung Vorrang; hierbei nimmt die temporäre Tracheotomie einen wichtigen Stellenwert für die Atemwegsicherung ein. Präventiv sind die konsequente Evaluierung „schwieriger Atemwegsverhältnisse“ und eine atraumatische Durchführung der direkten Laryngoskopie und endotrachealen Intubation von Bedeutung.

Schlüsselwörter

Endotracheale Intubation Komplikation Hypopharynxperforation Diagnostik Mediastinitis Kopf-Hals-Chirurgie Prävention 

Perforation of the hypopharynx as a rare life-threatening complication of endotracheal intubation

Abstract

Background

Endotracheal intubation is regarded as the gold standard technique to secure the airway with a low complication rate, however, perforating tracheal or esophageal injuries are rare but severe complications.

Materials and methods

Two cases of hypopharyngeal perforation after intubation are presented and discussed.

Results

While intubation of the first patient was anticipated to be difficult, the second patient did not present any risk factors. One patient developed a typical clinical pattern of difficult swallowing, soft tissue emphysema of the neck, pyrexia, and leukocytosis. The other initially showed minor symptoms but increasing difficulties in swallowing led to the diagnosis of a retropharyngeal abscess. A subsequent acute airway obstruction required emergency invasive airway access. In both cases surgical intervention in combination with antibiotic therapy resulted in complete healing.

Conclusions

Physicians performing endotracheal intubation or dealing with patients after intubation, should be aware of the clinical symptoms because only early diagnosis and therapy can prevent development of mediastinitis. In “cannot intubate-cannot ventilate” situations, wide bore transtracheal airway access under local anaesthesia and spontaneous breathing should have priority and temporary tracheotomy should also be considered. To prevent hypopharyngeal injury a thorough evaluation of the “difficult airway” and the atraumatic performance of direct laryngoscopy and endotracheal intubation are mandatory.

Keywords

Endotracheal intubation Complication Hypopharyngeal perforation Diagnosis Mediastinitis Surgery Prevention 

Notes

Danksagung

Für Hinweise bei der Abfassung des Manuskripts danken wir Frau Dr. med. Rotraud Neumann, Institut für Diagnostische und Interventionelle Radiologie, sowie Frau Dr. med. Rosemarie Fröber, Institut für Anatomie I, Klinikum der FSU Jena.

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

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Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.HNO-KlinikFriedrich-Schiller-UniversitätJena
  2. 2.Klinik für Anästhesiologie und IntensivtherapieFriedrich-Schiller-UniversitätJena
  3. 3.HNO-KlinikFriedrich-Schiller-UniversitätJena

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