title: Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery.
abstract: A 64-year-old male had an awake right nasal fiber-optic intubation with an endotracheal tube for open reduction and internal fixation of bilateral displaced mandibular fractures. After induction of anesthesia, an 18 Fr nasogastric tube (NGT) was inserted through the left nostril and was secured. The patient required high flow rates to deliver adequate tidal volumes with the ventilator. A chest x-ray done in the postanesthesia care unit revealed a malpositioned NGT in the left lower lobe bronchus, which was immediately removed. The patient was extubated on postoperative day 2. Various traditional methods, such as aspiration of gastric contents, auscultation of gastric insufflations, and chest x-ray are in use to detect or prevent the misplacement of an NGT. These methods can be unreliable or impractical. Use of capnography to detect an improperly placed NGT should be considered in the operating room as a simple, cost-effective method with high sensitivity to prevent possibly serious sequelae of an NGT placed within the bronchial tree.
authors.affiliation: Departments of * Anesthesiology and.
authors.forename: Arun
authors.initials: A
authors.lastname: Kalava
authors.affiliation: Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey.
authors.forename: Kirpal
authors.initials: K
authors.lastname: Clark
authors.affiliation: Oral & Maxillofacial Surgery, New York Methodist Hospital, Brooklyn, and.
authors.forename: John
authors.initials: J
authors.lastname: McIntyre
authors.affiliation: Departments of * Anesthesiology and.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Yarmush
authors.affiliation: Departments of * Anesthesiology and.
authors.forename: Teresita
authors.initials: T
authors.lastname: Lizardo
mesh_terms: D000762:Anesthesia Recovery Period; D001980:Bronchi; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000209:etiology*; D005593:Fracture Fixation, Internal / Q000379:methods; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation*; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery*; D008875:Middle Aged; D013902:Radiography, Thoracic; D012121:Respiration, Artificial / Q000379:methods; D013990:Tidal Volume
keywords: Misplacement; Nasogastric tube; Oral surgery