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Tracheal synechia visualized in flexible fibrobronchoscopy in induction of anesthesia for thoracic surgery
Sinequia traqueal objetivada mediante fibrobroncoscopia flexible en inducción anestésica reglada para cirugía torácica
T. Martínez Marivela
, M. Cortés Guerrero, M.I. Real Navacerrada
Corresponding author
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Doce de Octubre, Madrid, Spain
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Martínez Marivela, M. Cortés Guerrero, M.I. Real Navacerrada" "autores" => array:3 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Martínez Marivela" "email" => array:1 [ 0 => "teresa.martinez@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Cortés Guerrero" ] 2 => array:2 [ "nombre" => "M.I." "apellidos" => "Real Navacerrada" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Doce de Octubre, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sinequia traqueal objetivada mediante fibrobroncoscopia flexible en inducción anestésica reglada para cirugía torácica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 649 "Ancho" => 950 "Tamanyo" => 110784 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tracheal synechia spanning the trachea. Image of flexible fibrobronchoscopy in patient under general anesthesia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 59-year-old woman was programmed for video assisted thoracic surgery to remove a paravertebral mass compatible with neuroma located in T10. The patient's medical history consisted in deep venous thrombosis and pulmonary embolism following a uterine myoma resection, and an ICU stay 37 years ago for polytrauma following a traffic accident, requiring long term intubation but no laryngeal fracture.</p><p id="par0010" class="elsevierStylePara elsevierViewall">After induction of general anesthesia, we performed direct laryngoscopy to place a 37<span class="elsevierStyleHsp" style=""></span>Fr left double lumen tube. During the maneuver considerable resistance to tube placement was observed, and we changed to a smaller, size 35<span class="elsevierStyleHsp" style=""></span>Fr, tube; however, the problem persisted. We decided to perform flexible bronchoscopy which, after passing through the vocal folds, revealed the laryngeal lesion shown in the image (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>: yellow mark) spanning the trachea.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We decided to wake the patient up and reschedule surgery after evaluation by the otorhinolaryngologist.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally, after multidisciplinary discussion, it was decided to repeat the procedure and resect the tracheal synechia using rigid bronchoscopy and jet ventilation, and after that to perform the video assisted thoracic surgery.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez Marivela T, Cortés Guerrero M, Real Navacerrada MI. 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