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Anesthetic Management of Jael Syndrome With Impacted Blade in Close Proximity to the Internal Carotid Artery

A Case Report

Gluncic, Vicko, MD, PhD*,†; Lukić, Anita, MD, PhD; Hanko, Eva, MD*; Lynch, John, MD§

doi: 10.1213/XAA.0000000000000932
Case Reports

A patient presented with a stab injury caused by a knife penetrating the orbital floor and maxillary sinus along the skull base with the tip situated adjacent to the left internal carotid artery. A flexible fiberoptic bronchoscope loaded with an endotracheal tube was initially positioned superior to the vocal cords and advanced into the trachea immediately following induction. The blade was removed after occluding endovascular balloons were positioned distal and proximal to the potential internal carotid artery injury site. Therefore, contralateral nasal fiberoptic intubation might be safely performed in patients with unilateral maxillofacial trauma, no intracranial penetration, and minimal bleeding.

From the *Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois

Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Varaždin General Hospital, Varaždin, Croatia

§Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin.

Accepted for publication October 29, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Vicko Gluncic, MD, PhD, Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W Wellington Ave, Chicago, IL 60657. Address e-mail to

© 2019 International Anesthesia Research Society
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