title: Airway trauma in a high patient volume academic cardiac electrophysiology laboratory center.
abstract: BACKGROUND
  Providing anesthesia and managing airways in the electrophysiology suite can be challenging because of its unique setting outside of the conventional operating room. We report our experience of several cases of reported airway trauma including tongue and pharyngeal hematoma and vocal cord paralysis in this setting.
  
  
  METHODS
  We analyzed all of the reported airway trauma cases between December 2009 and January 2011 in our cardiac electrophysiology laboratories and compared these cases with those without airway trauma. Data from 87 cases, including 16 cases with reported airway trauma (trauma group) and 71 cases without reported airway trauma from the same patient population pool at the same period (control group), were collected via review of medical records.
  
  
  RESULTS
  Airway trauma was reported for 16 patients (0.7%) in 14 months among 2434 anesthetic cases. None of these patients had life-threatening airway obstruction. The avoidance of muscle relaxants during induction in patients with a body mass index less than 30 was found to be a significant risk factor for airway trauma (P = 0.04; odds ratio, 10; 95% confidence interval, 1.1-482). Tongue or soft tissue bite occurred in 2 cases where soft bite block was not used during cardioversion. No statistically significant difference was found between the trauma and the control groups for preprocedure anticoagulation, anticoagulation during the procedure, or reversal of heparin at the end of the procedure.
  
  
  CONCLUSIONS
  The overall incidence of reported airway trauma was 0.7% in our study population. Tongue injury was the most common airway trauma. The cause seems to have been multifactorial; however, airway management without muscle relaxant emerged as a potential risk factor. Intubation with muscle relaxant is recommended, as is placing a soft bite block and ensuring no soft tissue is between the teeth before cardioversion.
authors.affiliation: Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Yan
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Tanner
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Ara A
authors.initials: AA
authors.lastname: Chalian
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Savino
authors.forename: Lee A
authors.initials: LA
authors.lastname: Fleisher
authors.forename: Renyu
authors.initials: R
authors.lastname: Liu
mesh_terms: D000368:Aged; D058109:Airway Management / Q000379:methods*; D000768:Anesthesia, General; D000925:Anticoagulants / Q000009:adverse effects; D015992:Body Mass Index; D017115:Catheter Ablation / Q000009:adverse effects; D003710:Demography; D004554:Electric Countershock / Q000009:adverse effects; D005260:Female; D006406:Hematoma / Q000209:etiology; D006611:High-Frequency Jet Ventilation / Q000009:adverse effects; D006757:Hospital Units; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D010614:Pharynx / Q000293:injuries; D012137:Respiratory System / Q000293:injuries*; D012307:Risk Factors; D014059:Tongue / Q000293:injuries; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology
chemical_list: D000925:Anticoagulants; D009466:Neuromuscular Blocking Agents