Journal of The Korean Dental Society of Anesthesiology (대한치과마취과학회지)

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지

Massive Epistaxis during Nasotracheal Intubation

경비삽관 시도 중 발생한 심각한 비출혈

  • Jeon, Dae-Geun (Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University) ;
  • Song, Jaegyok (Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University) ;
  • Kim, Seok-Kon (Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University) ;
  • Ji, Seung-Heon (Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University)
  • 전대근 (단국대학교 의과대학 마취통증의학 교실) ;
  • 송재격 (단국대학교 의과대학 마취통증의학 교실) ;
  • 김석곤 (단국대학교 의과대학 마취통증의학 교실) ;
  • 지승헌 (단국대학교 의과대학 마취통증의학 교실)
  • Received : 2013.04.24
  • Accepted : 2013.06.28
  • Published : 2013.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

A 30-year-old man with morbid obesity (height: 176 cm, body weight: 100 kg, body mass index: 32.28) was scheduled for reconstruction of the mandibular fracture. During induction of general anesthesia and nasotracheal intubation, we experienced massive epistaxis, hypoxemia and difficult airway management. Fortunately, we performed oro-tracheal intubation with direct laryngoscopy and it barely succeeded. He recovered without any residual complications and rescheduled seven days later and we successfully performed awake fiberoptic nasotracheal intubation. The patient discharged on the fourth postoperative day.

Keywords

References

  1. Kim YC, Lee SH, Noh GJ, Cho SY, Yeom JH, Shin WJ, et al: Thermosoftening treatment of the nasotracheal tube before intubation can reduce epistaxis and nasal damage. Anesth Analg 2000; 91: 698-701. https://doi.org/10.1213/00000539-200009000-00038
  2. Kihara S, Komatsuzaki T, Brimacombe JR, Yaguchi Y, Taguchi N, Watanabe S: A silicone-based wire-reinforced tracheal tube with a hemispherical bevel reduces nasal morbidity for nasotracheal intubation. Anesth Analg 2003; 97: 1488-91.
  3. Inoue S, Fujimoto Y, Kawano Y, Furuya H: Difficult passage of the endotracheal tube and massive nasal bleeding during awake nasal fiberoptic intubation in a patient with airway obstruction caused by neck hematoma--a case report. Middle East journal of anesthesiology 2011; 21: 125-7.
  4. Kuo MJ, Reid AP, Smith JE: Unilateral nasal obstruction: an unusual presentation of a complication of nasotracheal intubation. J Laryngol Otol 1994; 108: 991-2.
  5. Scamman FL, Babin RW: An unusual complication of nasotracheal intubation. Anesthesiology 1983; 59: 352-3. https://doi.org/10.1097/00000542-198310000-00016
  6. Krebs MJ, Sakai T: Retropharyngeal dissection during nasotracheal intubation: a rare complication and its management. J Clin Anesth 2008; 20: 218-21. https://doi.org/10.1016/j.jclinane.2007.09.021
  7. Paul M, Dueck M, Kampe S, Petzke F, Ladra A: Intracranial placement of a nasotracheal tube after transnasal transsphenoidal surgery. Br J Anaesth 2003; 91: 601-4. https://doi.org/10.1093/bja/aeg203
  8. Lee JH, Kim CH, Bahk JH, Park KS: The influence of endotracheal tube tip design on nasal trauma during nasotracheal intubation: magill-tip versus murphy-tip. Anesth Analg 2005; 101: 1226-9, table of contents. https://doi.org/10.1213/01.ane.0000169293.59514.28
  9. Morimoto Y, Sugimura M, Hirose Y, Taki K, Niwa H: Nasotracheal intubation under curve-tipped suction catheter guidance reduces epistaxis. Can J Anaesth 2006; 53: 295-8. https://doi.org/10.1007/BF03022218
  10. Seo KS, Kim JH, Yang SM, Kim HJ, Bahk JH, Yum KW: A new technique to reduce epistaxis and enhance navigability during nasotracheal intubation. Anesth Analg 2007; 105: 1420-4, table of contents. https://doi.org/10.1213/01.ane.0000281156.64133.bd
  11. El-Seify ZA, Khattab AM, Shaaban AA, Metwalli OS, Hassan HE, Ajjoub LF: Xylometazoline pretreatment reduces nasotracheal intubation-related epistaxis in paediatric dental surgery. Br J Anaesth 2010; 105: 501-5. https://doi.org/10.1093/bja/aeq205
  12. Arendt KW, Khan K, Curry TB, Tsen LC: Topical vasoconstrictor use for nasal intubation during pregnancy complicated by cardiomyopathy and preeclampsia. Int J Obstet Anesth 2011; 20: 246-9. https://doi.org/10.1016/j.ijoa.2010.11.010
  13. Ahmed-Nusrath A, Tong JL, Smith JE: Pathways through the nose for nasal intubation: a comparison of three endotracheal tubes. Br J Anaesth 2008; 100: 269-74. https://doi.org/10.1093/bja/aem350