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Difficult airway due to cervical haemorrhage caused by spontaneous rupture of a parathyroid adenoma: A case report

World Journal of Clinical Cases 2023年第5期11卷 1217-1223页

作者： Yong-Zheng Han Yang Zhou Ying Peng Jin Zeng Yu-Qing Zhao Xiao-Ru Gao Hong Zeng Xiang-Yang Guo Zheng-Qian Li Department of Anesthesiology Peking University Third HospitalBeijing 100191China Beijing Center Quality Control and Improvement on Clinical AnesthesiaBeijing 100191China Department of General Surgery Peking University Third HospitalBeijing 100191China Department of Otorhinolaryngology Head and Neck Surgery Peking University Third HospitalBeijing 100191China Department of Radiology Peking University Third HospitalBeijing 100191China Department of Anesthesiology Haidian Maternal and Child Health Care HospitalBeijing 100191China

BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway *** SUMMARY A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without *** Airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway ***, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.

关键词： Cervical haemorrhage Parathyroid adenoma muscle relaxants Difficult airway Case report

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