goscope to secure the airway. They can also perform a transtracheal and superi-
or laryngeal block before performing an awake intubation.
Expecting the unexpected
Are patients with difficult airways susceptible to intubation-related injuries? A
provider's abilities make a difference in reducing the risks, but the patient's
body habitus, dentition and airway anatomy mark the line between problematic
and traumatic intubations.
Whenever a provider places a laryngoscope blade in the mouth, his wrist is
fixed. He pushes up and away to lift the jaw and reveal the glottis. When he
can't initially see the glottis, he manipulates the blade, sometimes forcefully, to
find the view, which can cause inadvertent injuries. Additionally, multiple
attempts to access the glottis can cause airway edema, which might compro-
mise the airway.
You can break or loosen teeth and cut lips trying to establish an airway when
conventional intubation techniques aren't working and you're forced to ad lib and
manipulate the blade, prying back the jaw to gain access to the glottis. Bleeding is
the most common problem during nasal intubation. It obstructs your view, and if
you fracture the turbinate, you can create a whole host of problems. Traumatic
retropharyngeal dissection creates a false passage. Pushing through that "pouch"
would cause dramatic bleeding, impossible conditions for intubation and infection
risks. This type of injury is rare but dangerous, requiring the skills of an ENT spe-
cialist.
Broken teeth are much more dramatic and problematic for patients than a
post-op sore throat, which is a relatively common side effect of repeated
attempts at airway intubation. Dental events are often the result of provider
error, but a patient's poor dentition could also contribute to the injury. Who or
what's to blame is often traced to the documentation of dentition during the
pre-op assessment.
January 2015 O U T PAT I E N TS U R G E R Y. N E T 2 9
