Case 29 - Postoperativehematoma and airway compromise after carotid endarterectomy

Summary

This chapter presents a case study of a 76-year-old female arrived in the postanesthesia care unit (PACU) after an uneventful left carotid endarterectomy (CEA) for a severe left internal carotid artery stenosis. On emergence from anesthesia, she developed severe hypertension requiring intravenous nitroglycerin boluses as well as intravenous labetalol. Airway management is often challenging in the PACU or critical care unit. Postoperative bleeding after CEA is particularly hazardous because bleeding into a closed space can quickly result in an expanding neck hematoma that can cause impingement on laryngeal structures and airway compromise. In cases of progressive expansion of the neck hematoma, even in the absence of airway compromise, awake intubation may be prudent, followed by surgical exploration of the wound and drainage of the hematoma. If ventilation is unsuccessful or becomes inadequate despite drainage of the neck hematoma, invasive airway access should proceed.