Unexpected Left Endobronchial Intubation in a Case of Turner's Syndrome

Turner's症候群在心包引流後發生左側支氣管內管置入之病例報告

劉文競(Wen-Ching Liu) ； 黃昌博(Chang-Bor Hwang) ； 鄭嘉遜(Robin Ka-Shun Cheng) ； 吳世銓(Rick Sai-Chuen Wu) ； 許汝寧(Yu-Ling Hui) ； 譚培炯(Peter P.C. Tan)

《Acta Anaesthesiologica Sinica》 35卷4期 (1997/12) Pp. 253-256

摘要

Patients with Turner's syndrome present a multiplicity of cardiovascular and airway abnormalities. We describe a case of Turner's syndrome with pericardial effusion who experienced an inadvertent endobronchial intubation due to displacement of the endotracheal tube immediately after the pericardial drainage. A sudden increase of airway pressure and decrease of oxygen saturation in the presence of breathing sound audible via the chest piece placed on the left hemithorax first misled us to call our attention to sputum impaction. No sputum was obtainable from airway suction. Inadvertent bronchial intubation was highly suspected at the post-anesthesia room when a decrease of right side breathing sound was noted together with a progressive fall of oxygen saturation. Emergent chest x-ray confirmed the diagnosis. It was thought that the mishap took place early in the act of or following the pericardial drainage. Our case serves as evidence once again to emphasize the possibility of endobronchial intubation due to displacement of endotracheal tube during anesthesia and the importance of monitoring to guard against inadvertent bronchial intubation, particularly in patients with associated problems such as Turner's syndrome with huge pericardial effusion.

關鍵字

Turner's syndrome ； Complication: left endobronchial intubation

並列摘要

在處理Turner's症候群的病人的全身麻醉時，麻醉科醫師可能會遭遇插管困難的現象。我們提出一個Turner's症候群的麻醉病例報告。雖然順利的使用光纖內視鏡的幫助，經鼻孔插入氣管，但在手術進行中卻意外的滑入左側支氣管而造成右肺塌陷，所以在全身麻醉下，即便是持續地使用聽診器監聽左肺呼吸聲，在發生呼吸道壓力上升或病人缺氣情形下，要考慮是否氣管內管滑入左側支氣管，尤其是頸部較短的病人。

並列關鍵字

Turner's症候群 ； 併發症：左側支氣管內管置入