Cut Throat Injuries - A Challenge for Airrway and Anaesthesia Management- Case Repor 5 Cases

Abstract

Introduction: Patients may present with airway compromise, aspiration, acute blood loss with hypoxemia because of injury to airway and major vessels; may be accidental, suicidal or homicidal. Case Report: We are reporting 5 cases which presented in casualty and for emergency surgeries.Of the 5 cases 2 were female, 2 males and one male child, adults in the age group of 20-40 years. 2 males had suicidal injuries and the rest were homicidal, had laceration to larynx, oesophagus with one bleeding profusely at the level of thyroid cartilage. Tracheotomy was done to one adult female patient and for the other 3 patients endo tracheal tube (ETT) was introduced in to trachea through the wound. Blood, fluids transfused, induced with inj Ketamine and maintained with Isoflurane + oxygen and Vecuronium. Closure of the oesophagus and tracheal wounds was done. Shifted to ICU for elective ventilation. The child was brought unconscious, IV line secured , Isolyte-p started , 4 sized plain ETT was pushed into the trachea through the wound and 100 % oxygen with sevoflurane started , maintained with Oxygen, nitrous oxide and Isoflurane, Atracurium and Fentanyl,blood loss replaced. Baby not reversed and shifted to ICU. Discussion and Conclusion: Securing the airway should be the first priority if unstable or with oedema, may have to undergo cricothyroidotomy or urgent tracheotomy. Hemodynamic stabilisation to treat the Blood loss. Surgical repair is also a priority and to end without complications. Avoiding hypoxia and aspiration; maintaining adequate intravascular status and avoiding hemodynamic collapse; adequate ICU care ,post operative counselling is necessary. These patients belonged to lower socioeconomic strata and with a lot of psycho-social problems which require proper counselling and follow up to avoid further similar injuries.