[Case of pharyngeal laceration associated with the use of airwayscope in a patient with difficult airway].
A 54-year-old woman with atlantoaxial subluxation in rheumatoid arthritis was scheduled for total elbow arthroplasty. Since her neck was stabilized with a cervical collar and her interincisor distance was 1.5 finger-breadth, a difficult airway was anticipated. Anesthesia was induced with propofol and fentanyl. Mask ventilation was barely achieved with difficulty Then insertion of an Intlock with Airwayscope (AWS) into the pharynx was attempted but could not be performed because of restriction of neck mobility and small mouth opening. Although only Intlock separated from AWS could be inserted into the pharynx, oropharyngeal bleeding occurred and we could not obtain an appropriate view on the monitor. Following aspiration of blood, the trachea was intubated using a flexible fiberoptic bronchoscope under AWS guidance. After the operation, a view of bronchoscopy by an otolaryngologist revealed three lacerations from the mucosa to muscle layer in the pharynx. The lacerations could have resulted from use of AWS in a patient with a small mouth opening and with vulnerable mucosa due to long-term steroid therapy.
Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto 390-8621.
Takemi
T
Sekiguchi
Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto 390-8621.
Yuki
Y
Sugiyama
Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto 390-8621.
Tomoyuki
T
Kawamata
Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto 390-8621.
Mikito
M
Kawamata
D000758:Anesthesia; D001172:Arthritis, Rheumatoid / Q000601:surgery; D057929:Arthroplasty, Replacement, Elbow; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D022125:Lacerations / Q000209:etiology* / Q000473:pathology; D020704:Laryngoscopes / Q000009:adverse effects*; D008875:Middle Aged; D010614:Pharynx / Q000293:injuries*