Abstract
Removal of foreign objects from the thoracic cavity could be performed by open or video-assisted surgeries. Anaesthesia for such cases could be demanding which would require one lung ventilation and intubation in unfamiliar positions. Depending on the extent of underlying injuries, sudden haemodynamic collapse should be anticipated, and precautions should be taken to manage such occurrences. We present a unique case of a safely conducted anaesthesia and surgery for a thoracoscopic removal of a long-bladed knife. One lung ventilation with a double lumen endotracheal tube placed at right lateral position in the absence of a fiber–optic bronchoscopy with improvisation using available equipment is described. According to our knowledge, the former has not been reported elsewhere in the literature.
Highlights
Even though being a relatively rare form of trauma, thoracic impalement injuries carry high morbidity and mortality.[1]
We present a case of a safe removal of an impaled knife utilizing a conventional double lumen endotracheal tubes (DLT) placement in lateral position and video-assisted thoracoscopy (VAT)
When single lung ventilation is demanded, several options are available whereas DLT placement is one of the commonly adopted techniques
Summary
Even though being a relatively rare form of trauma, thoracic impalement injuries carry high morbidity and mortality.[1] In cases of retained knife blade injuries, unplanned extractions could lead to massive haemorrhage, hemodynamic collapse and even death.[2] One-lung-ventilation (OLV) with double lumen endotracheal tubes (DLT) may be required and positioning could prove to be challenging.[1] We present a case of a safe removal of an impaled knife utilizing a conventional DLT placement in lateral position and video-assisted thoracoscopy (VAT). Pale, conscious, rational and haemodynamically stable with a pulse rate of 94 bpm and blood pressure of 124/76 mmHg. pale, conscious, rational and haemodynamically stable with a pulse rate of 94 bpm and blood pressure of 124/76 mmHg He was tachypnoeic with a respiratory rate of 30 per minute with no subcutaneous emphysema. Pneumothorax and haemothorax were excluded by clinical examination, chest radiograph (Figure 1) and ultrasound chest
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