title: Entrapment of a nasopharyngeal temperature probe: an unusual complication during an apparently uneventful elective revision laparoscopic Nissen fundoplication.
abstract: We report the first case of nasopharyngeal temperature probe entrapment during an apparently uneventful elective revision laparoscopic Nissen fundoplication that precipitated a continuous quality improvement project at our institution. We describe changes in our clinical practice that resulted from this occurrence and envision these modifications will have a positive influence on patient care.
authors.affiliation: Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. wass.thomas@mayo.edu
authors.forename: C Thomas
authors.initials: CT
authors.lastname: Wass
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Long
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
mesh_terms: D000328:Adult; D005260:Female; D018662:Fundoplication / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D009305:Nasopharynx; D012086:Reoperation; D013821:Thermometers / Q000009:adverse effects*