Perioperative Management of a Patient With Tongue Cancer Who Developed Pneumomediastinum Following Tracheostomy Performed to Secure the Airway
Prior to a scheduled operation for a 45-year-old male patient with tongue cancer, a tracheotomy performed under intravenous sedation to prevent asphyxia due to extensive bleeding resulted in pneumomediastinum and subcutaneous emphysema. The planned operations were postponed until reduction of the pneumomediastinum was confirmed. During operation, airway pressure was kept low to prevent tension pneumomediastinum along with a sufficient depth of anesthesia, controlled analgesia, and continuous administration of muscle relaxants. Postoperatively, sedation was used to avoid stress and complications with the vascular anastomosis site. In this case, air leakage into the soft tissues was one of the possible causes of the event associated with increased airway pressure. Although the incidence of such complications is relatively low, caution should be exercised after tracheostomy.

Axial computed tomography images obtained 2 days after the emergent tracheostomy.
Left: Subcutaneous emphysema (red arrows) inside the clavicle at the second thoracic vertebral level. Right: Pneumomediastinum (red arrows) at the fifth vertebral level.

Axial computed tomography images obtained 1 week after the emergent tracheostomy.
Subcutaneous emphysema and pneumomediastinum have almost disappeared.
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