2 8 S U P P L E M E N T T O O U T PAT I E N T S U R G E R Y M A G A Z I N E January 2015
A
lthough intubation-related trauma is rare, it
occurs often enough to demand your attention,
according to a study published in Best Practice &
Research Clinical Anaesthesiology (tinyurl.com/q8fwjs6).
Here's what the study says about some common damage
caused by heavy-handed intubation.
• Lip injuries — lacerations, hematomas, edema and teeth
abrasions — are typically caused by inattentive or inexperienced
providers. The injuries are more nuisance than serious problem,
and typically resolve on their own.
• Dental injuries that occur during laryngoscopy account for half of dental trauma during surgery.
The injuries are most common in pediatric patients with periodontal disease or fixed dental work and in
any patient when intubation proves difficult. Advise high-risk patients of potential dental damage, and
consider the use of tooth guards, even though they might obstruct views of the airway.
Save a tooth that's been knocked out in moist gauze or normal saline. An oral surgeon or dentist may
be able to save it if they act within an hour of the trauma.
• Tongue swelling can occur if the patient's neck is flexed significantly while a bite block is in
place. A patient might also lose sensation in his tongue due to nerve injury caused by forceful laryn-
goscopy or if a supraglottic airway device is improperly placed or placed with an over-inflated cuff.
• Damage to the uvula can cause sore throat, odynophagia, painful swallowing, coughing, foreign
body sensation and serious life-threatening airway obstruction. Sore throat occurs after approximately
40% of intubations. Notably, applying topical anesthesia to the end of the endotracheal tube does not
lower the risk, and may in fact increase it.
• Trauma to the larynx and vocal cords is largely dependent on the intubation skills of providers
and the difficulty of the airway. Patients typically respond to conservative therapy, although those with
persistent hoarseness should consult with an ENT physician.
— Daniel Cook
aIrWay ISSuES
5 Potential Intubation Injuries
z CLOSE WATCH Intubation-relat-
ed trauma is rare, but occurs often
enough to demand your attention.
