Anesth Pain Med.  2017 Apr;12(2):187-190. 10.17085/apm.2017.12.2.187.

Acute traumatic injury and delayed airway obstruction after the use of a GlideScope in a patient with a difficult airway: A case report

• Song SH
• Lee WH
• Chung W
• Lee JY
• Youn Ann M

• KMID: 2379743
• DOI: http://doi.org/10.17085/apm.2017.12.2.187

Abstract

Endotracheal intubation sometimes leads to complications, particularly in patients with anticipated difficult intubation. The GlideScope is preferred because of its high success rate in cases with anticipated difficult intubation. However, complications during the process have been reported. Most minor injuries can be treated after early detection. However, treatment can be difficult if complications occur later. We report a patient who underwent an emergency tracheostomy due to a delayed airway obstruction caused by pharyngeal wall bleeding during intubation with a GlideScope.

Keyword

Airway management; Difficult airway; Endotracheal intubation; GlideScope; Tracheostomy

MeSH Terms

Airway Management
Airway Obstruction*
Emergencies
Hemorrhage
Humans
Intubation
Intubation, Intratracheal
Tracheostomy

Figure

• 

  Fig. 1 Neck computed tomography showing a diffuse soft tissue swelling in the oropharynx and supraglottic area with suspected hemorrhage or hematoma in the airway suggestive of active bleeding.

• 

  Fig. 2 A huge mucosal lesion with continuous bleeding originating from the postpharyngeal wall.

Reference

1. Freiberger JJ. An unusual presentation of an airway tear. Anesthesiology. 1984; 61:204–6. DOI: 10.1097/00000542-198408000-00017. PMID: 6465604.

2. Sun DA, Warriner CB, Parsons DG, Klein R, Umedaly HS, Moult M. The GlideScope Video Laryngoscope:randomized clinical trial in 200 patients. Br J Anaesth. 2005; 94:381–4. DOI: 10.1093/bja/aei041. PMID: 15567809.

3. Leong WL, Lim Y, Sia AT. Palatopharyngeal wall perforation during Glidescope intubation. Anaesth Intensive Care. 2008; 36:870–4. PMID: 19115660.

4. Chin KJ, Arango MF, Paez AF, Turkstra TP. Palatal injury associated with the GlideScope. Anaesth Intensive Care. 2007; 35:449–50. PMID: 17591148.

5. Chen EH, Logman ZM, Glass PS, Bilfinger TV. A case of tracheal injury after emergent endotracheal intubation:a review of the literature and causalities. Anesth Analg. 2001; 93:1270–1. DOI: 10.1097/00000539-200111000-00047. PMID: 11682412.

6. Cho K, Kim MH, Lee W, Lee JH, Lim SH, Lee KM, et al. The oropharyngeal bleeding after esophageal stethoscope insertion:A case report. Anesth Pain Med. 2016; 11:104–8. DOI: 10.17085/apm.2016.11.1.104.

7. Domino KB, Posner KL, Caplan RA, Cheney FW. Airway injury during anesthesia:a closed claims analysis. Anesthesiology. 1999; 91:1703–11. DOI: 10.1097/00000542-199912000-00023. PMID: 10598613.

8. O’Neill JE, Giffin JP, Cottrell JE. Pharyngeal and esophageal perforation following endotracheal intubation. Anesthesiology. 1984; 60:487–8. DOI: 10.1097/00000542-198405000-00019. PMID: 6711859.

9. Hawkins DB, Seltzer DC, Barnett TE, Stoneman GB. Endotracheal tube perforation of the hypopharynx. West J Med. 1974; 120:282–6. PMID: 4821706. PMCID: PMC1129425.

10. Difficult Airway Society Extubation Guidelines Group. Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, et al. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia. 2012; 67:318–40. DOI: 10.1111/j.1365-2044.2012.07075.x. PMID: 22321104.

11. Aziz MF, Healy D, Kheterpal S, Fu RF, Dillman D, Brambrink AM. Routine clinical practice effectiveness of the Glidescope in difficult airway management:an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions. Anesthesiology. 2011; 114:34–41. DOI: 10.1097/ALN.0b013e3182023eb7. PMID: 21150569.

12. Dupanović M, Jensen R. Optimizing GlideScope laryngoscopy:an in vitro study on an airway model. Anesthesiology. 2007; 106:886–8. DOI: 10.1097/01.anes.0000264773.71791.11. PMID: 17413944.

13. Dupanovic M. Maneuvers to prevent oropharyngeal injury during orotracheal intubation with the GlideScope video laryngoscope. J Clin Anesth. 2010; 22:152–4. DOI: 10.1016/j.jclinane.2009.06.003.