Anesthetic management of a patient with severe subcutaneous and mediastinal emphysema due to pertussis infection

Satoshi Ideno, Noriko Miyazawa, Saki Ishikawa, Rie Wakamiya, Atsushi Shinto, Hiromi Mikasa, Shinichi Yamamoto

Research output: Contribution to journalArticlepeer-review


A 20-month-old girl, with respiratory failure due to severe subcutaneous and mediastinal emphysema, was scheduled to undergo percutaneous drainage of emphysema and induction of extracorporeal membrane oxygenation. Paroxysm, a symptom of the infection of Bordetella pertussis, was the cause of emphysema. In patients with severe neck subcutaneous emphysema management of difficult airway is the most important safety issue in the practice of anesthesia. Following the American Society of Anesthesiologist (ASA) guidelines for management of difficult airway, we prepared various types of equipment to facilitate intubation and surgeons were beside the patient during induction of anesthesia for emergency invasive airway access. To prevent the progression of emphysema preservation of spontaneous breathing during the perioperative period was also important. Combined with propofol and midazolam, pethidine was an effective agent for safe anesthetic induction because it produces less respiratory depression compared to other opiate analgesics. In conclusion, this case demonstrates the importance of prediction of and preparation for difficult airway. Furthermore, anesthesiologists should consider the optimization of anesthesia to avoid progression of emphysema.

Original languageEnglish
Pages (from-to)671-674
Number of pages4
JournalJapanese Journal of Anesthesiology
Issue number6
Publication statusPublished - 2014 Jun
Externally publishedYes


  • Bordetella pertussis
  • Difficult airway
  • Mediastinal emphysema
  • Pethidine
  • Subcutaneous emphysema

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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