Aortic injury and physiologically difficult airway: A case report

Blunt thoracic trauma can lead to aortic dissection and a physiologically difficult airway. Early thoracic endovascular aortic repair (TEVAR) is recommended under general anesthesia and can be complicated by peri-intubation adverse events. We report a 33-year-old male with a thoracic aortic injury who developed oxygen desaturation and severe hypotension during anesthetic induction and tracheal intubation before TEVAR. Imaging revealed an expanding left hemothorax, and he was revived with mechanical ventilation, nor-adrenaline, blood transfusion, aortic stenting, and evacuation of left hemothorax. Post-operative care was continued in the trauma intensive care unit. He was extubated uneventfully two days later and discharged from the hospital after a further 8 days. Despite the patient not being elderly or emergently intubated for critical illness, many recommendations from the INTUBE study for the management of a physiologically difficult airway may hold relevance, such as first-pass intubation success, intubation by consultant anesthetist, use of video-laryngoscope, and non-use of propofol for induction. Risk assessment and maintenance of oxygenation and organ perfusion remain paramount.