Surgery/Anesthesia | February 2011
Silent Pain in the Neck
A 60-year-old man with no significant past medical history underwent an elective anterior cervical discectomy for persistent right arm weakness due to cervical stenosis. After an uncomplicated procedure, the patient was transferred to a surgical unit with stable vital signs. Later that night, he developed tightness and swelling on the right side of his neck. The nurse notified the covering physician, who asked about stridor or other respiratory symptoms. When told they were absent, he recommended continued close observation. Over the next few hours, the patient's symptoms persisted, and he noted the onset of mild dysphagia. The nurse contacted the in-house intensivist, who evaluated the patient and once again found no evidence of respiratory distress or stridor.
A few hours later, the patient stood up from bed to use the urinal, began coughing, turned cyanotic, and fell to the floor unconscious. Cardiopulmonary resuscitation was started, but the patient's airway was significantly compromised by a now obvious neck hematoma. An emergent tracheostomy was performed at the bedside and the patient was transferred to the intensive care unit.
This postoperative complication led to a prolonged hospitalization. The patient was discharged to a skilled nursing facility, where he required lengthy rehabilitation services.
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