title: Intracranial violation by nasotracheal suction catheter in a patient with a history of transsphenoidal surgery.
abstract: A 37-year-old woman underwent transsphenoidal surgery for recurrent pituitary adenoma. Postoperatively, she had a prolonged intensive care unit stay and repeated tracheal intubations because of inadequate airway reflexes. On postoperative day 25, she had difficulty maintaining her airway, and the nursing staff attempted orotracheal suctioning, which failed. Nasotracheal suctioning was then performed. Her level of consciousness declined, warranting reintubation. Computed tomography showed diffuse pneumocephalus and a new parenchymal hemorrhage. The only temporally related event was use of a nasotracheal catheter. This case suggests that nasotracheal suctioning may not be safe in patients who have recently undergone transsphenoidal procedures.
authors.affiliation: From the *Anesthesiology Residency, University of Kansas School of Medicine-Wichita; †Via Christi Hospital on N. St. Francis; and ‡Via Christi Hospitals Wichita, Inc., Wichita, Kansas.
authors.forename: Brianne M
authors.initials: BM
authors.lastname: Owens
authors.forename: James
authors.initials: J
authors.lastname: Walker
authors.forename: Beryl
authors.initials: B
authors.lastname: Silkey