Anaesthetic Management in a Case of Penetrating Orbitocranial Trauma: A Case Report
Vol 8 | Issue 2 | May-August 2022 | Page: 22-24 | Ashish Kannaujia, Suruchi Ambasta, Chetna Shamshery, Uma Srivastava, Anita Malik
Author: Ashish Kannaujia , Suruchi Ambasta , Chetna Shamshery , Uma Srivastava , Anita Malik 
 Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India.
Address of Correspondence
Dr. Ashish Kannaujia,
Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India.
We herein report a case of a 19-year-old male with penetrating orbitocranial injury due to a metallic rod. The patient presented with a penetrating left orbital injury extending into the cranium. Though vision was intact patient was in severe distress and agony. CT scan was done which showed a left orbital roof fracture with an intracranial extension of the metallic rod. Left frontal craniotomy under general anaesthesia was planned. This case has been reported to highlight how the anticipated difficulty in mask ventilation, laryngoscopy and endotracheal intubation due to the presence of metallic rod was overcome with the insertion of I-gel.
Keywords: I-gel, Penetrating eye injury, Metallic rod
1. Lin HL, Lee HC, Cho DY. Management of transorbital brain injury. J Chin Med Assoc. 2007; 70:36–8.
2. Turbin RE, Maxwell DN, Langer PD, Frohman LP, Hubbi B, Wolansky L, et al. Patterns of transorbital intracranial injury: A review and comparison of occult and non-occult cases. Surv Ophthalmol. 2006; 51:449–60.
3. Seçer M, Ergüngör MF, Dalgıç A, Okay HÖ, Dağlıoğlu E, Acar OA. Transorbital brain injury by a metalic fragment: A case report. Turk Neurosurg. 2007; 17:163–5.
4. Gazzaz M, Lmejjati M, Akhaddar A, Derraz S, Aghzadi, El Khamlichi A. Paediatric penetrating orbitocranial injury with a pencil – a report of two cases. Pan Arab J Neurosurg 2000; 4:2
5. Singh A, Kumar Bhasker S, Kumar Singh B. Transorbital penetrating brain injury with a large foreign body. J Ophthalmic Vis Res. 2013; 8:62–5.
6.Miscusi M, Arangi P, De Martino L. An unusual case of orbito-frontal rod fence stab injury with good outcome. Surgery. 2013; 13:31–6. 10.1186/1471-2482-13-31
7.Yin YH, Dhanireddy S, Braley AE. Management of an Unusual Orbitocranial Penetrating Injury: Case Reports in Ophthalmological Medicine, Volume 2020, Article ID 9070595, 5 pages https://doi.org/10.1155/2020/9070595
8. Goto T et al Advancing emergency airway management practice and research; Acute Medicine & Surgery 2019; 6: 336–351
9. Singh I, Gupta M, Tandon M. Comparison of Clinical Performance of I-Gel™ with LMA—Proseal™ in Elective Surgeries. Indian J Anaesth. 2009 June; 53(3): 302–305.
10. Trivedi V, Patil B. A Clinical Comparative Study of Evaluation of Proseal LMA V/S I-GEL For Ease Of Insertion And Hemodynamic Stability; A Study Of 60 Cases. The Internet Journal of Anesthesiology Volume 27Number 2
11. Emmerich M, Dummler R. Use of the I-gel laryngeal mask for management of a difficult airway. Anaesthesist. 2008 Aug;57(8):779-81.
12. Asai T. Successful use of I-gel in three patients with difficult intubation and difficult ventilation. Masui. 2011 Jul;60(7):850-2.
13. Emmerich M, Tiesmeier J. The I-gel supraglottic airway: a useful tool in case of difficult fiberoptic intubation.Minerva Anestesiol. 2012 Oct;78(10):1169-70.
14. Gupta L, Bhadoria P: The I-Gel™ airway for Difficult Intubation. The Internet Journal of Anesthesiology. 2008 Volume 18 Number 1.
15. Gibbison B, Cook TM, Seller C. Case series: protection from aspiration and failure of protection from aspiration with the I-gel airway. British Journal of Anaesthesia 100 (3): 415–17 (2008)
16. Kim YH. Pulmonary aspiration associated with supraglottic airways: Proseal laryngeal mask airway and I-Gel. Korean J Anesthesiol 2012 December 63(6): 489-490.
17. Ismail SA, Bisher NA, Kandil HW, Mowafi HA, Atawia HA. Intraocular pressure and haemodynamic responses to insertion of the I-gel, laryngeal mask airway or endotracheal tube.Eur J Anaesthesiol. 2011 Jun; 28(6):443-8.
18. V. Uppal, G. Fletcher and J. Kinsella. Comparison of the I-gel with the cuffed tracheal tube during pressure-controlled ventilation. British Journal of Anaesthesia 102 (2): 264–8 (2009)
19. Maharjan SK. I-gel for Positive Pressure Ventilation. JNMA J Nepal Med Assoc. 2013 Jan-Mar; 52(189):255-9.
20. Siddiqui AS, Raees US, Siddiqui SZ, Haider S, Raza SA. Comparison of performance and safety of I-gel with laryngeal mask airway (classic) for general anaesthesia with controlled ventilation. Anaesth Pain & Intensive Care 2010; 14(1):17-20.)
|How to Cite this Article: Kannaujia A, Ambasta S, Shamshery C, Srivastava U, Malik A
| Anaesthetic Management in a Case of Penetrating Orbitocranial Trauma: A Case Report | Journal of Anaesthesia and Critical Care Case Reports | May-August 2022; 8(2): 22-24.
Tags: I Gel, Metallic rod, Penetrating eye injury