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Canadian Journal of Anaesthesia

, Volume 47, Issue 2, pp 165–168 | Cite as

Subcutaneous emphysema following trans-cricothyroid membrane injection of local anesthetic

  • David T. WongEmail author
  • Glenn P. McGuire
Clinical Reports

Abstract

Purpose: To present a case of preoperative subcutaneous emphysema (SCE) as a complication of trans-cricothyroid membrane (TCM) injection of lidocaine for awake intubation.

Clinical features: A 48-yr-old man with cervical myelopathy was scheduled for elective cervical discectomy. Airway topical anesthesia consisted of lidocaine pledgets and TCM injection. After successful awake fibreoptic intubation was performed, SCE was noted in the neck region. The main differential diagnosis of preoperative SCE included air leak via the anterior needle track from TCM injection or disruption of mucosal membrane in the aerodigestive tract. The latter was excluded by panendoscopy and an upper G1 swallow study. The most likely explanation for SCE was air leak from the anterior needle tract. The subcutaneous emphysema resolved spontaneously without sequella.

Conclusion: Subcutaneous emphysema is a rare but potentially serious complication of TCM injection of lidocaine. Anesthesiologists should be familiar with the differential diagnosis, investigations and management of SCE.

Keywords

Aerodigestive Tract Mediastinitis Subcutaneous Emphysema Cervical Myelopathy Fibreoptic Bronchoscopy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Présenter un cas d’emphysème sous-cutané préopératoire (ESC) comme complication d’une injection de lidocaïne au travers de la membrane cricothyroïdienne (MCT) lors d’une intubation vigile.

Éléments cliniques: Un homme de 48 ans présentant une myélopathie cervicale devait subir une discectomie cervicale. L’anesthésie topique des voies aériennes comprenait des tampons de lidocaïne et une injection au travers de la MCT. Une intubation fibroscopique vigile a été réalisée avec succès, mais un ESC a été noté ensuite dans la région du cou. Le diagnostic différentiel d’ESC préopératoire incluant une fuite d’air provenant du tractus antérieur emprunté par l’aiguille lors de l’injection dans la MCT ou une rupture de la membrane muqueuse du tractus aéro-digestif. Cette dernière a été rejetée par la panendoscopie et une étude G1 supérieure de la déglutition. L’explication la plus plausible d’un ESC a été une fuite d’air du tractus antérieur emprunté par l’aiguille. L’emphysème sous-cutané s’est résorbé spontanément sans séquelles.

Conclusion: L’emphysème sous-cutané est une complication rare mais potentiellement grave d’une injection de lidocaïne au travers de la MCT. Les anesthésiologistes doivent se familiariser avec le diagnostic différentiel, l’évaluation et le traitement de l’ESC.

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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  1. 1.From the Department of Anesthesia, Toronto Western HospitalUniversity of TorontoOntarioCanada

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