Various Anaesthetic Techniques used in the Management of Traumatic Diaphragmatic Hernia: A Series of Three Cases
Traumatic diaphragmatic hernia is relatively uncommon and occurs most commonly after a road traffic accident (5%). Diaphragmatic rupture is mostly associated with vital organ injuries such as the liver, spleen, lungs, bones, pelvis, and brain, which can be severely damaged. The anaesthetic managem...
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Private Limited
2023-10-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/18591/65356_CE[Ra1])_F(IS)_QC(SHK_RDW_IS)_PF1(VD_KM)_PN(KM).pdf |
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| author | Geetha Soundarya Udayakumar Haanah Mounika Nunna |
| author_facet | Geetha Soundarya Udayakumar Haanah Mounika Nunna |
| author_sort | Geetha Soundarya Udayakumar |
| collection | DOAJ |
| description | Traumatic diaphragmatic hernia is relatively uncommon and occurs most commonly after a road traffic accident (5%). Diaphragmatic
rupture is mostly associated with vital organ injuries such as the liver, spleen, lungs, bones, pelvis, and brain, which can be severely
damaged. The anaesthetic management of a patient presenting with traumatic diaphragmatic hernia depends on any associated
vital organ injuries. Hereby, the author present a case series of three patients with traumatic diaphragmatic hernia with different
presentations managed accordingly. In the first case, a 37-year-old male presented with diaphragmatic hernia and cervical spine
fracture following a road traffic accident. Awake fibreoptic intubation was performed with utmost care to avoid further injury to the
cervical spine. After intubation, positive pressure ventilation was given with low tidal volume to avoid barotrauma and to expand the
atelectatic lung. The second case involved a 48-year-old male with a history of falling from a height one week prior, who presented
with right-sided diaphragmatic rupture and a liver contusion. Intubation was performed using a left-sided double-lumen tube, and
one-lung ventilation was applied to facilitate thoracotomy. A thoracic paravertebral block was administered to alleviate postoperative
pain, providing good pain relief. In the third case, a 56-year-old male with a known case of Chronic Obstructive Pulmonary Disease
(COPD) presented to the hospital following a road traffic accident. The patient had lung contusion and haemopneumothorax with
poor pulmonary reserve, and required emergency surgical repair. Combined spinal-epidural anaesthesia was preferred over general
anaesthesia, as intubation may cause bronchospasm and life-threatening complications in COPD patients. |
| first_indexed | 2024-03-11T14:47:25Z |
| format | Article |
| id | doaj.art-cc7e71be6b5a4042b1afce95c803cf88 |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-03-11T14:47:25Z |
| publishDate | 2023-10-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-cc7e71be6b5a4042b1afce95c803cf882023-10-30T10:49:57ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2023-10-011710010310.7860/JCDR/2023/65356.18591Various Anaesthetic Techniques used in the Management of Traumatic Diaphragmatic Hernia: A Series of Three CasesGeetha Soundarya Udayakumar0Haanah Mounika Nunna1Assistant Professor, Department of Anaesthesiology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.Junior Resident, Department of Anaesthesiology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.Traumatic diaphragmatic hernia is relatively uncommon and occurs most commonly after a road traffic accident (5%). Diaphragmatic rupture is mostly associated with vital organ injuries such as the liver, spleen, lungs, bones, pelvis, and brain, which can be severely damaged. The anaesthetic management of a patient presenting with traumatic diaphragmatic hernia depends on any associated vital organ injuries. Hereby, the author present a case series of three patients with traumatic diaphragmatic hernia with different presentations managed accordingly. In the first case, a 37-year-old male presented with diaphragmatic hernia and cervical spine fracture following a road traffic accident. Awake fibreoptic intubation was performed with utmost care to avoid further injury to the cervical spine. After intubation, positive pressure ventilation was given with low tidal volume to avoid barotrauma and to expand the atelectatic lung. The second case involved a 48-year-old male with a history of falling from a height one week prior, who presented with right-sided diaphragmatic rupture and a liver contusion. Intubation was performed using a left-sided double-lumen tube, and one-lung ventilation was applied to facilitate thoracotomy. A thoracic paravertebral block was administered to alleviate postoperative pain, providing good pain relief. In the third case, a 56-year-old male with a known case of Chronic Obstructive Pulmonary Disease (COPD) presented to the hospital following a road traffic accident. The patient had lung contusion and haemopneumothorax with poor pulmonary reserve, and required emergency surgical repair. Combined spinal-epidural anaesthesia was preferred over general anaesthesia, as intubation may cause bronchospasm and life-threatening complications in COPD patients.https://www.jcdr.net/articles/PDF/18591/65356_CE[Ra1])_F(IS)_QC(SHK_RDW_IS)_PF1(VD_KM)_PN(KM).pdfcombined spinal-epiduraldouble-lumen tubefibreoptic intubationthoracic paravertebral block |
| spellingShingle | Geetha Soundarya Udayakumar Haanah Mounika Nunna Various Anaesthetic Techniques used in the Management of Traumatic Diaphragmatic Hernia: A Series of Three Cases Journal of Clinical and Diagnostic Research combined spinal-epidural double-lumen tube fibreoptic intubation thoracic paravertebral block |
| title | Various Anaesthetic Techniques used in the Management of Traumatic Diaphragmatic Hernia: A Series of Three Cases |
| title_full | Various Anaesthetic Techniques used in the Management of Traumatic Diaphragmatic Hernia: A Series of Three Cases |
| title_fullStr | Various Anaesthetic Techniques used in the Management of Traumatic Diaphragmatic Hernia: A Series of Three Cases |
| title_full_unstemmed | Various Anaesthetic Techniques used in the Management of Traumatic Diaphragmatic Hernia: A Series of Three Cases |
| title_short | Various Anaesthetic Techniques used in the Management of Traumatic Diaphragmatic Hernia: A Series of Three Cases |
| title_sort | various anaesthetic techniques used in the management of traumatic diaphragmatic hernia a series of three cases |
| topic | combined spinal-epidural double-lumen tube fibreoptic intubation thoracic paravertebral block |
| url | https://www.jcdr.net/articles/PDF/18591/65356_CE[Ra1])_F(IS)_QC(SHK_RDW_IS)_PF1(VD_KM)_PN(KM).pdf |
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