Anaesthetic considerations in primary repair of tracheobronchial injury following blunt chest trauma in paediatric age group: Experience of two cases
A 5-year-old male child was admitted as an emergency following a blunt chest trauma. Early clinical examination showed signs of haemorrhagic shock with severe respiratory distress and right sided tension pneumothorax. A wide bore needle was inserted in 2nd intercostal space. Pneumothorax was confirmed by an urgent bed side chest X-ray. After inserting a chest drain and adequate fluid resuscitation, patient's vital parameters improved. Emergency CT scan showed massive pneumothorax with suspicion of right main bronchus injury. Patient's blood investigations were within the normal limits.\nAfter intravenous induction with ketamine 30 mg and succinylcholine 25 mg, patient's trachea was intubated with 5 mm uncuffed ETT. FOB revealed discontinuation of right main bronchus about 2 cm from its origin from carina. Left endobronchial intubation achieved with the help of FOB. After placing the child in left lateral position, a diagnostic thoracoscopy was done, which revealed no associated mediastinal injuries. Rest of the perioperative course was uneventful and was similar to the first case.