4^th International Anesthesia and Pain Medicine Conference

A 55-year old female patient underwent conservative mastectomy for removal of malignant breast mass,after uneventful surgery and anesthesia course the patient discharged to PACU then to the world fullyawake and hemodynamically stable. Two hours later the patient has got severe cough tinged with blood and emphysema which has increased and extended to thorax. CT scan was done, pneumomediastinum and pneumothorax was found, fiber optic laparoscopy was done and tracheal tear was found. Decision was taken to correct the tear surgically, challenging anesthesia case for intervention. We decided to do general anesthesia -diprivan, fentanyl and bridion was given, intubation was done with single lumen tube as lung isolation is needed, we advanced the tube to be endobronchial in right side so as to make one lung ventilation with a single lumen tube. Double lumen tube to make lung isolation to correct the tracheal tear will cause more trauma and may cause rupture of the tear during extubation. As the course of surgery and intubation of this patient was smooth and the case complicated by tracheal tear we found a lot of case reports reporting same. In European Journal of Cardiothoracic Surgery, a systematic review concluded that, 182 cases in 50 studies of post intubation

tracheal tear and overall mortality was 22%. The main presentation in these cases was pneumothorax and pneumomedistinum. Most of the cases were of females, over 50 years of age and immune compromised same as our patient. Surgical correction was done by primary sutures and does not need any flaps, the tear was corrected and lung inflation was done. Under water seal was inserted and was moving freely. Two days later emphysema subsided, the patient was hemodynamically stable, saturation and blood gases were normal, patient was comfort and active and on the third day she was discharged.