From the Guidelines
Transtracheal blocks can cause several potential side effects, including bleeding at the injection site, subcutaneous emphysema, and hematoma formation, as well as more serious complications such as tracheal perforation and recurrent laryngeal nerve damage 1. The most common complications of transtracheal blocks include:
- Bleeding at the injection site
- Subcutaneous emphysema (air trapped under the skin)
- Hematoma formation More serious but less frequent side effects include:
- Tracheal perforation
- Esophageal perforation
- Recurrent laryngeal nerve damage leading to vocal cord paralysis
- Inadvertent intravascular injection of the anesthetic agent which can cause systemic toxicity Patients may experience temporary hoarseness, coughing, or difficulty swallowing after the procedure 1. In rare cases, respiratory distress can occur due to laryngospasm or airway edema, which may require immediate intervention. Infection at the injection site is possible but uncommon with proper sterile technique. These complications are generally more likely in patients with abnormal neck anatomy, coagulopathies, or when the procedure is performed by less experienced practitioners. The risk-benefit profile should be carefully considered, especially in patients with bleeding disorders or those on anticoagulant medications, as these factors may increase the risk of bleeding complications 1. It is essential to weigh the potential benefits of transtracheal blocks against the potential risks and to take steps to minimize these risks, such as using proper sterile technique and carefully selecting patients for the procedure 1.
From the Research
Potential Side Effects of Transtracheal Blocks
The potential side effects of transtracheal blocks can be understood by examining the complications associated with similar procedures. Some of the possible side effects include:
- Complications such as catheter displacement, total expiratory obstruction, pneumothorax, and subcutaneous emphysema have been encountered in percutaneous transtracheal jet ventilation 2
- Local anesthetic toxicity, which can lead to neurological symptoms such as seizures and altered mental status, has been reported in cases of interscalene block and transversus abdominis plane block 3, 4
- Infection is a potential risk, as demonstrated by the isolation of Branhamella catarrhalis in transtracheal aspirates of patients with acute exacerbation of chronic bronchitis 5
- Cardiac complications, including cardiac arrest, can occur due to local anesthetic toxicity 4
Minimizing Side Effects
To minimize the risk of side effects, it is essential to:
- Ensure proper technique and patient selection for transtracheal blocks
- Use appropriate doses and types of local anesthetics
- Maintain effective communication between healthcare providers, such as anesthesiologists and surgeons, to avoid overdoses or misadministration of local anesthetics 4
- Monitor patients closely for signs of complications or toxicity during and after the procedure 2, 3, 4