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British Journal of Anaesthesia, 2004, Vol. 92, No. 2 298
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Correspondence

Acute fatal haemorrhage during percutaneous dilatational tracheostomy

S. Gwilym1 and A. Cooney1

1 Milton Keynes, UK

Editor—Having read the case report1 and related study of neck vessel anatomy by Shlugman and colleagues, we wish to add our own experience and offer a further anatomical basis for the practice of ultrasound scanning before percutaneous dilatational tracheostomy (PDT). It was previously not our practice to scan patients before PDT until we experienced a single case of profound arterial bleeding requiring surgical intervention. The vessel responsible was identified as a ‘thyroid ima’ artery (lowest thyroid artery/Naubauer’s artery), which exists in 2–12% of the population. This normal variant of neck anatomy may, if not identified, lead to significant morbidity. The importance of considering this vessel is increased in the Asian population, in whom anatomical studies have identified a higher incidence.2 It is now our practice to scan for vessels before PDT and specifically exclude a thyroid ima artery.

S. Gwilym

A. Cooney

Milton Keynes, UK

References

1 Shlugman D, Satya-Krishna R, Loh L. Acute fatal haemorrhage during percutaneous dilatational tracheostomy. Br J Anaesth 2003; 90: 517–20[Abstract/Free Full Text]

2 Toni R, Della Casa C, Mosca S, Malaguti A, Castorina S, Roti E. Anthropological variations in the anatomy of the human thyroid arteries. Thyroid 2003;13: 183–92[Medline]


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