Between the devil and the deep red sea: Airway trauma during introducer-guided difficult intubation

Publication date: Available online 11 April 2019Source: Trends in Anaesthesia and Critical CareAuthor(s): Shreya Agarwal, Preeti GuptaAbstractA 46-year-old woman was scheduled for total thyroidectomy and had modified Mallampati class III airway. After anaesthesia was induced, laryngoscopy revealed Cormack–Lehane grade 3a view of the vocal cords with external laryngeal manipulation. A Portex single-use tracheal tube introducer was first introduced up to 27 cm mark, after eliciting the tracheal click and hold-up signs. A Portex tracheal tube size 7 mm ID was railroaded over the introducer with some difficulty because of resistance, necessitating anticlockwise rotatory movements to slide the tube in, and the cuff was inflated. After intubation, there was a gush of blood through the tracheal tube. Correct placement was confirmed with capnography, and peak airway pressure was 32 cmH2O. Repeated suctioning was performed through the tracheal tube, and the bleeding subsided gradually. On withdrawal, the tip of the introducer was found to have blood stain. A check bronchoscopy revealed soft tissue trauma at the carina. The patient was ventilated again, and airway pressure dropped to 19 cmH2O. Her intra- and post-operative courses were uneventful. She was discharged 3 days after the operation without any further sequelae. While single-use introducers are useful in cases of difficult intubation, their use has been associated with airway trauma. We review the current use of single-...
Source: Trends in Anaesthesia and Critical Care - Category: Anesthesiology Source Type: research