Anesthetic Challenges in the Management of an Unusual Penetrating Neck Injury: A Case Report

Abstract

Penetrating neck injuries can be life-threatening, particularly when involving Zone I, where major vascular and airway structures are located. We present the case of a 40-year-old man with a stab wound to the anterior neck and a knife retained in situ. Despite the injury, he remained hemodynamically stable, and imaging demonstrated a small pneumothorax without evidence of vascular or aerodigestive injury. Airway management represented the main anesthetic challenge, as any manipulation of the neck could result in displacement of the blade. Point-of-care gastric ultrasound demonstrated an empty stomach, allowing induction without rapid sequence intubation. Video laryngoscopy using an Eschmann guide was performed with the neck maintained in a neutral position, followed by uneventful surgical removal of the knife under multidisciplinary supervision. The postoperative course was uncomplicated. This case highlights the importance of careful airway management, multidisciplinary coordination, and gastric ultrasound for assessing aspiration risk in trauma patients. A structured, team-based approach may facilitate safe anesthetic and surgical management of penetrating cervical injuries involving retained foreign bodies.