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Table of Contents
LETTER TO EDITOR
Year : 2016  |  Volume : 32  |  Issue : 1  |  Page : 125

In response to unanticipated cannot intubate situation due to difficult mouth opening


Department of Anesthesia, Critical Care and Pain, Tata Memorial Centre, Mumbai, Maharashtra, India

Date of Web Publication4-Feb-2016

Correspondence Address:
Dr. Raghu Sudarshan Thota
Department of Anesthesia, Critical Care and Pain, 2nd Floor, Main Building, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.175725

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How to cite this article:
Thota RS, Purohit R, Solanki SL. In response to unanticipated cannot intubate situation due to difficult mouth opening. J Anaesthesiol Clin Pharmacol 2016;32:125

How to cite this URL:
Thota RS, Purohit R, Solanki SL. In response to unanticipated cannot intubate situation due to difficult mouth opening. J Anaesthesiol Clin Pharmacol [serial online] 2016 [cited 2019 Dec 9];32:125. Available from: http://www.joacp.org/text.asp?2016/32/1/125/175725

Sir,

We read with the interest case report "Unanticipated cannot intubate situation due to difficult mouth opening" by Akasapu et al.[1] published in January-March 2015 issue 1 volume 31. We have some queries regarding the management of this case: The use of 100mg of rocuronium in an ASA grade IV E patient can be confounding. Furthermore authors should have attempted bag mask ventilation (BMV) without sellick's maneuver after their first attempt of BMV with sellick's maneuver failed.[2] Also it would have been prudent to consider cricothyroidotomy in a patient who is rapidly desaturating.

We also encountered a similar case of unanticipated cannot intubate situation in a 64-year-old and 50 kg, ASA I female, posted for right radical parotidectomy with posterior segmental mandibulectomy with free anterolateral thigh flap reconstruction. Her airway examination was normal with the mouth opening of 3 cm and mallampatti class I with a full range of neck movements. Airway plan was to secure the nasotracheal tube. Anesthesia was induced with propofol 120 mg and fentanyl 100 μg. Rocuronium of 50 mg was given for neuromuscular blockade after confirmation of BMV. After 3 min of BMV, an attempt to open the mouth for laryngoscopy was failed, teeth were firmly approximated. BMV was continued for another minute. Sevoflurane 2% with oxygen was used during BMV at the fresh gas flow of 2 l/min. Another attempt to open the mouth was also failed. Masseter muscles spasm and temporomandibular joint dislocation were ruled out by the surgeons. The surgeon tried to open the mouth with the help of mouth gag but failed again. We decided to intubate the trachea with the help of fiber optic bronchoscope (FOB) through nasal route and continued BMV till FOB arrived. We successfully managed this stressful situation with FOB.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Akasapu KR, Wuduru S, Padhy N, Durga P. Unanticipated cannot intubate situation due to difficult mouth opening. J Anaesthesiol Clin Pharmacol 2015;31:123-4.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Neilipovitz DT, Crosby ET. No evidence for decreased incidence of aspiration after rapid sequence induction. Can J Anaesth 2007;54:748-64.  Back to cited text no. 2
    




 

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