Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjan.2012.09.004
Brazilian Journal of Anesthesiology
Clinical Informations

Obstrução das vias aéreas com risco para a vida, causada por edema de via aérea superior e inchaço cervical significativo depois do trabalho de parto/parto

Life-threatening airway obstruction due to upper airway edema and marked neck swelling after labor and delivery

Junko Ushiroda; Satoki Inoue; Junji Egawa; Yasunobu Kawano; Masahiko Kawaguchi; Hitoshi Furuya

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Resumo

EXPERIÊNCIA E OBJETIVOS: Em geral, alterações nas vias aéreas ocorrem em grávidas normais; no entanto, essas alterações podem gerar situações críticas em populações específicas. OBJETIVOS: Esse artigo apresenta o caso de uma paciente que entrou em choque por causa de sangramento atônico em seguida a parto vaginal de natimorto. RELATO DE CASO: Mulher com 32 anos com sangramento atônico em seguida a parto vaginal de natimorto foi transferida para nosso hospital. A paciente manifestou choque e seu estado respiratório estava em progressiva deterioração. Ficou evidenciada obstrução das vias aéreas causada por inchaço cervical e edema faringolaríngeo. Tentamos intubação traqueal utilizando laringoscopia direta e indireta. No entanto, não foi possível inserir qualquer dos dispositivos de laringoscopia tentados. Depois de várias tentativas com TrachlightTM, finalmente obtivemos sucesso com a intubação. Depois da histerectomia, a paciente foi internada na unidade de terapia intensiva (UTI), onde ficou em tratamento durante cinco dias. Ao receber alta da UTI, tinha escore de Mallampati I-II. Durante sua estadia na UTI, seu peso diminuiu de 60 kg para 51 kg. CONCLUSÕES: É provável que episódios simultâneos de trabalho de parto/parto e de ressuscitação com fluidos pioraram suficientemente o edema de via aérea e o inchaço cervical a ponto de causar obstrução aguda das vias aéreas e dificuldade na laringoscopia.

Palavras-chave

Trabalho de parto, Via aérea difícil, Edema de via aérea

Abstract

BACKGROUND AND OBJECTIVES: Airway changes generally occur in normal gravidas; however, these changes could cause critical situations in specific populations. OBJECTIVES: This article presents the case of a difficult airway patient that went into shock because of atonic bleeding after vaginal delivery for stillbirth. CASE REPORT: A 32-yr-old woman with atonic bleeding after vaginal delivery for stillbirth was transferred to our hospital. She manifested shock, and her respiratory condition was progressively deteriorating. Airway obstruction caused by neck swelling and pharyngolaryngeal edema was apparent. We tried tracheal intubation using direct and indirect laryngoscopes. However, it turned out that insertion of the laryngoscopic devices to the oral cavity was impossible. After several attempts using the TrachlightTM, successful intubation was finally made. After hysterectomy, she was admitted to the intensive care unit (ICU) and treated for five days. At discharge from the ICU, her Mallampati score was I-II. Her body weight decreased 60 kg to 51 kg during ICU stay. CONCLUSIONS: We believe that concomitant attacks of labor and delivery and fluid resuscitation probably worsened upper airway and neck edema enough to cause acute airway obstruction and difficult laryngoscopy.

Keywords

Labor and delivery, Difficult airway, Airway edema

References

Boutonnet M, Faitot V, Katz A. Mallampati class changes during pregnancy, labour, and after delivery: can these be predicted?. Br J Anaesth. 2010;104:67-70.

Kodali BS, Chandrasekhar S, Bulich LN. Airway changes during labor and delivery. Anesthesiology. 2008;108:357-62.

Bhavani-Shankar K, Lynch EP, Datta S. Airway changes during cesarean hysterectomy. Can J Anaesth. 2000;47:338-41.

Pilkington S, Carli F, Dakin MJ. Increase in Mallampati score during pregnancy. Br J Anaesth. 1995;74:638-42.

Farcon EL, Kim MH, Marx GF. Changing Mallampati score during labour. Can J Anaesth. 1994;41:50-1.

Iohom G, Ronayne M, Cunningham AJ. Prediction of difficult tracheal intubation. Eur J Anaesthesiol. 2003;20:31-6.

Ochroch EA, Eckmann DM. Clinical application of acoustic reflectometry in predicting the difficult airway. Anesth Analg. 2002;95:645-9.

Heller PJ, Scheider EP, Marx GF. Pharyngolaryngeal edema as a presenting symptom in preeclampsia. Obstet Gynecol. 1983;62:523-4.

Rocke DA, Scoones PG. Rapidly progressive laryngeal oedema associated with pregnancy-aggravated hypertension. Anaesthesia. 1992;47:141-3.

Dobb G. Laryngeal oedema complicating obstetric anaesthesia. Anaesthesia. 1978;33:839-40.

Procter AJM, White JB. Laryngeal oedema in pregnancy. Anaesthesia. 1983;38.

Mackenzie AI. Laryngeal oedema complicating obstetric anaethesia: Three cases. Anaesthesia. 1978;33:271-2.

Jouppila R, Jouppila P, Hollmn A. Laryngeal oedema as an obstetric anaesthesia complication. Acta Anaethesiol Stand. 1980;24:97-8.

Bhavani-Shankar K, Lynch EP, Datta S. Airway changes during cesarean hysterectomy. Can J Anaesth. 2000;47:338-41.

Falk JL, O'Brien JF, Kerr R. Fluid resuscitation in traumatic hemorrhagic shock. Crit Care Clin. 1992;8:323-40.

Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98:1269-77.

Agrò F, Hung OR, Cataldo R. Lightwand intubation using the Trachlight: a brief review of current knowledge. Can J Anaesth. 2001;48:592-9.

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