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  • Expedited awake tracheal intubation using ropivacaine topicalisation for the evacuation of a postoperative neck haematoma in the presence of lignocaine allergy

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Anaesthesia
Expedited awake tracheal intubation using ropivacaine topicalisation for the evacuation of a postoperative neck haematoma in the presence of lignocaine allergy
  1. Walston Martis1 and
  2. Rani Chahal1,2
  1. 1Department of Cancer Anaesthesia, Perioperative and Pain medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  2. 2Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Rani Chahal; Rani.chahal{at}petermac.org

Abstract

Progressive airway compromise from a neck haematoma is a feared complication of head and neck surgery that can rapidly lead to death if not urgently intervened upon. We report a case of a patient developing a progressively expanding neck haematoma on the first postoperative night after parotidectomy and neck dissection for malignancy. Although he did not have respiratory compromise or stridor, ultrasound examination of his airway revealed marked tracheal deviation, and flexible nasoendoscopy showed significant supraglottic swelling. The decision was made for an awake fibreoptic intubation; however, a complicating factor was a history of lignocaine allergy. This case report describes the unconventional use of atomised ropivacaine in a concentration of 0.5% for topicalisation of the airway. Along with conscious sedation with remifentanil, ropivacaine provided excellent conditions for awake intubation, following which a significant amount of blood was evacuated from the face and neck.

  • Anaesthesia
  • Ear, nose and throat/otolaryngology

https://doi.org/10.1136/bcr-2023-256695

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    Footnotes

    • Twitter @DrRaniChahal

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: WM, RC. The following authors gave final approval of the manuscript: WM, RC. Is the patient one of the authors of this manuscript? No.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.