A Case of Successful Tracheal Tube Exchange With McGrath MAC for Tube Damage During Oral Surgery

A patient undergoing a bilateral sagittal split and LeFort 1 maxillary osteotomy performed under general anesthesia required emergent intraoperative exchange of a potentially damaged nasotracheal tube. This exchange was smoothly performed under constant indirect visualization using the McGrath MAC video laryngoscopy system. After the exchange, ventilation of the patient dramatically improved. The removed endotracheal tube was torn 19 cm from the distal tip. The McGrath MAC was useful for visualizing the glottis and confirming the entire course of the tube exchange despite the patient's having a difficult airway (Cormack-Lehane grade 3).

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TO STUDY THE CORRELATION BETWEEN SONOGRAPHIC MODIFICATION OF CORMACK LEHANE SCORING WITH ACTUAL CL GRADING DURING DIRECT LARYNGOSCOPY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i11.756 ◽

2019 ◽

Vol 3 (11) ◽

Author(s):

Dr. Vishal Koundal

Keyword(s):

Difficult Airway ◽

Endotracheal Intubation ◽

Clinical Assessment ◽

Direct Laryngoscopy ◽

Himachal Pradesh ◽

Keywords Ultrasound ◽

Airway Assessment ◽

Lehane Grade ◽

Significant Difference ◽

Grade 3

Background: Airway assessment is an essential aspect of preanaesthetic assessment. Presently, prediction of difficult airway is based on clinical assessment of airway. Methods: Prospective Observational conducted at Department of Anesthesiology, Dr. RPGMC Kangra at Tanda, Himachal Pradesh. Results: It was observed that 44% patients (n=88) were in grade 2 followed by 27 % (n=54) in grade 1, grade 3 was observed in 24.5% patients (n=49) whereas Cormack Lehane grade 4 was seen in 4.5% patients (n=9) Conclusion: The thyromental distance was more than 6.5 cm in the majority of patients (87.5%) while 12.5% had a thyromental distance less than 6.5 cm. There was a significant difference in Thyromental distance between different Cormack Lehane grades (P=0.001) Keywords: Ultrasound, endotracheal intubation, direct laryngoscopy

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Nasogastric Tube Knotted Around a Nasal Endotracheal Tube in the Nasopharynx: Possible Cause

Anesthesia Progress ◽

10.2344/anpr-67-04-01 ◽

2021 ◽

Vol 68 (2) ◽

pp. 90-93

Author(s):

Yunosuke Okada ◽

Hanako Ohke ◽

Hiroyo Yoshimoto ◽

Misato Kobashi ◽

Masato Saitoh ◽

...

Keyword(s):

General Anesthesia ◽

Endotracheal Tube ◽

Nasogastric Tube ◽

Dental Treatment ◽

Oral Surgery ◽

Simple Procedure ◽

Possible Cause

A nasogastric tube is often used along with a nasal endotracheal tube during oral surgery or dental treatment under general anesthesia. Although the insertion of a nasogastric tube is a simple procedure, it can be associated with complications that lead to potentially serious consequences. The knotting of a nasogastric tube around an endotracheal tube is rare. Here, we report a case in which the nasogastric tube became knotted around the nasal endotracheal tube in the nasopharynx. We compare this case with 4 previous similar cases and provide a theory of how the nasogastric tube might have become knotted.

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Oral to Nasal Endotracheal Tube Exchange in a Difficult Airway: A Novel Method

Anesthesiology ◽

10.1097/00000542-200211000-00048 ◽

2002 ◽

Vol 97 (5) ◽

pp. 1324-1325 ◽

Cited By ~ 14

Author(s):

Amitabh Dutta ◽

Pramila Chari ◽

Ram A. Mohan ◽

Yogesh Manhas

Keyword(s):

Difficult Airway ◽

Endotracheal Tube ◽

Tube Exchange ◽

Novel Method

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Comparing McGRATH® MAC, C-MAC®, and Macintosh Laryngoscopes Operated by Medical Students: A Randomized, Crossover, Manikin Study

BioMed Research International ◽

10.1155/2016/8943931 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8

Author(s):

Myungju Shin ◽

Sun Joon Bai ◽

Ki-Young Lee ◽

Ein Oh ◽

Hyun Joo Kim

Keyword(s):

Medical Students ◽

Difficult Airway ◽

Success Rate ◽

Similar Amount ◽

Intubation Time ◽

Normal Airway ◽

Macintosh Blade ◽

Mcgrath Mac ◽

Lehane Grade ◽

Difficulty Score

We hypothesized that the McGRATH MAC would decrease the time of intubation compared to C-MAC for novices. Thirty-nine medical students who had used the Macintosh blade to intubate a manikin fewer than 3 times were recruited. The participants performed sequential intubations on the manikin in two simulated settings that included a normal airway and a difficult airway (tongue edema). The intubation time, success rate of intubation, Cormack-Lehane grade at laryngoscopy, and difficulty using the device were recorded. Each participant was asked to identify the device that was most useful. The intubation time decreased significantly and by a similar amount to the McGRATH MAC and C-MAC compared to the Macintosh blade (P<0.001andP=0.017, resp.). In the difficult airway, the intubation times were similar among the three devices. The McGRATH MAC and C-MAC significantly increased the success rate of intubation, improved the Cormack-Lehane grade, and decreased the difficulty score compared to the Macintosh blade in both airway settings. The majority of participants selected the McGRATH MAC as the most useful device. The McGRATH MAC and C-MAC may offer similar benefits for intubation compared to the Macintosh blade in normal and difficult airway situations.

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A two-bougie technique for safer oro- to nasotracheal tube exchange in a difficult airway

Anaesthesia ◽

10.1111/j.1365-2044.2010.06551.x ◽

2010 ◽

Vol 65 (12) ◽

pp. 1231-1232 ◽

Cited By ~ 1

Author(s):

A. Wadehra ◽

M. S. Tandon ◽

P. Ganjoo

Keyword(s):

Difficult Airway ◽

Tube Exchange ◽

Nasotracheal Tube

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Difficult Nasal Intubation Using Airway Scope® for a Child With Large Tumor

Anesthesia Progress ◽

10.2344/anpr-65-04-08 ◽

2018 ◽

Vol 65 (4) ◽

pp. 251-254

Author(s):

Tomoka Matsumura ◽

Chihiro Suzuki ◽

Kazumasa Kubota ◽

Shunsuke Minakuchi ◽

Haruhisa Fukayama

Keyword(s):

General Anesthesia ◽

Difficult Airway ◽

Endotracheal Tube ◽

Upper Airway ◽

Nasal Intubation ◽

Large Tumor ◽

Magill Forceps ◽

Airway Scope ◽

Glottic View ◽

Experience Difficulty

We report a case of difficult nasal intubation utilizing a Pentax-Airway scope® AWS-100. A 4-month-old female with a rapidly growing melanotic neuroectodermal tumor was scheduled for resection under general anesthesia. The tumor was a large rubbery mass located in the middle of the mandible. For nasal intubation using the AWS, guidance of the tube toward the glottis was attempted using pediatric Magill forceps. Although we could hold the tube with the Magill forceps, it was difficult to insert the tube into the trachea due to the limited space in her hypopharynx. We then used a standard laryngoscope with a Miller straight blade for direct visual laryngoscopy and successfully intubated the patient with the aid of the pediatric Magill forceps. We often experience difficulty navigating a nasal endotracheal tube toward the glottis even when a clear glottic view is obtained with video laryngoscopes, especially in children with a small oropharyngeal space. However, some reports have been shown that video laryngoscopes are useful for intubation of the difficult airway and causes less stress to the upper airway than direct visual laryngoscopy. Video laryngoscopy can be an excellent way to provide nasal intubation in some but not all children.

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Clinical Use of Preformed Microcuff® Pediatric Endotracheal Tubes in Japan

Anesthesia Progress ◽

10.2344/anpr-67-04-03 ◽

2021 ◽

Vol 68 (1) ◽

pp. 45-46

Author(s):

Wakana Oda ◽

Hiroshi Hanamoto ◽

Aiko Oyamaguchi ◽

Eriko Togawa ◽

Yuka Honjyo ◽

...

Keyword(s):

Exchange Rate ◽

Endotracheal Tube ◽

Oral Surgery ◽

Clinical Use ◽

Efficacy And Safety ◽

Japanese Children ◽

Endotracheal Tubes ◽

Unplanned Extubations ◽

Tube Exchange ◽

The Exchange Rate

Preformed cuffed oral endotracheal tubes are widely used to intubate children undergoing oral surgery. To evaluate the efficacy and safety of oral Ring-Adair-Elwyn (RAE) Microcuff® pediatric endotracheal tubes, we retrospectively investigated the endotracheal tube exchange rate and associated complications in Japanese children younger than 2 years of age undergoing cheiloplasty or palatoplasty. The exchange rate was 3.5%, and although unplanned extubations occurred in 2 patients, no severe complications were observed. Our results suggest that oral RAE Microcuff® tubes are effective and safe for intubating Japanese children younger than 2 years of age, with a low tube exchange rate and minor complications.

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Mucosal Changes in the Trachea and Main Bronchi of Newborn Infants after Nasotracheal Intubation

Anaesthesia and Intensive Care ◽

10.1177/0310057x7500300306 ◽

1975 ◽

Vol 3 (3) ◽

pp. 209-217 ◽

Cited By ~ 7

Author(s):

G. C. Fisk ◽

W. de C. Baker

Keyword(s):

Endotracheal Tube ◽

Main Bronchus ◽

Squamous Metaplasia ◽

Nasotracheal Intubation ◽

Newborn Infants ◽

Respiratory Epithelium ◽

Lower Trachea ◽

Nasotracheal Tube ◽

Mucosal Changes ◽

The Right

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.

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