NECK HEMATOMA AFTER CENTRAL VENOUS CATHETERIZATION AND AWAKE INTUBATION AS RESCUE AIRWAY MANAGEMENT TECHNIQUE: A CASE REPORT/HEMATOM NA VRATU NAKON KATETERIZACIJE CENTRALNE VENE I INTUBACIJA NA BUDNO KAO ZBRINJAVANJE DISNOGA PUTA: PRIKAZ SLUCAJA

Central venous catheterization (CVC) of the internal jugular vein is an invasive procedure commonly performed in anesthesiology practice. Usually it is an uneventful procedure but complications such as bleeding, infection, and potential damage to the surrounding structures can occur. One of the complications is neck hematoma, which can distort airway anatomy and cause upper airway obstruction. We present a patient who underwent endovascular mitral valve repairment procedure under general anesthesia. Accidental puncture of carotid artery occurred while attempting to place the central line. Later, during awakening in the coronary intensive care unit, the patient developed neck hematoma. The diagnosis was confirmed with multi-slice computed tomography (MSCT) and MSCT angiography showed active arterial blood extravasation. Despite it, the patient was extubated. Awake tracheal intubation (ATI) with video laryngoscopy was the technique of choice for reintubation because of the neck swelling and compression onto laryngeal structures. In this case, rushed extubation put the patient at risk. Video laryngoscopy ATI with appropriate preparation and titrated sedation can enable quick and safe rescue airway management in patients with rapidly developing neck hematoma, along with definitive evacuation and treatment. Key words: Neck hematoma; Advanced airway management; Central venous catheterization Postavljanje centralnog venskog katetera (CVK) u unutarnju jugularnu venu je invazivan postupak koji se cesto izvodi u anestezioloskoj praksi. Obicno je bez komplikacija, no mogu se dogoditi komplikacije poput krvarenja, infekcije i potencijalnog ostecenja okolnih struktura. Jedna od komplikacija je i hematom vrata koji moze narusiti anatomiju disnih putova i uzrokovati opstrukciju gornjih disnih putova. Prikazani bolesnik podvrgnut je endovaskularnom popravku mitralnog zaliska u opcoj anesteziji. Tijekom pokusaja postavljanja CVK-a doslo je do slucajne punkcije karotidne arterije. Kasnije, tijekom budenja u koronarnoj jedinici, bolesnik je razvio hematom na vratu. Dijagnoza je potvrdena MSCT-om, a MSCT angiografja pokazala je aktivnu ekstravazaciju krvi. Unatoc tome, bolesnik je ekstubiran. Intubacija na budno (ATI) s video laringoskopom bila je tehnika izbora za reintubaciju zbog otoka vrata i kompresije na disni put. U prikazanom slucaju ishitrena ekstubacija je bolesnika dovela u opasnost. ATI s video laringoskopom uz odgovarajucu pripremu i titriranu sedaciju moze omogu