An Unusual CompliCation
of
Nsl-Tracheal Anestesia
Michael E. Barkin, DDJS.1 and Norman Trieger, D.MD., MD.2
Nasal-tracheal intubation is commonly used for most head and neck procedures including dental and oral surgical operations. Various complications are reported in the literature, many of these deal with the mechanical diffculty of the nasal route.' 2'3 This report concerns a complication which is related to intra-operative trauma with subsequent postoperative necrosis of the skin over the ala of the nose. (Figure 1) We
In all cases, it is preventable with proper armamentarium. The two factors contributing to the necrosis was the position of the nasal tracheal tube and the length of the procedure. This complication has been eliminated in subsequent procedures of comparable length by ( 1) cutting the tube length as it exits the nose, (after successful intubation and confirming bilateral lung expansion and equal breath sounds), (2) A 1350 angle adapter' is placed in the tube insuring a low proffle, (3) A flexible connector is then used between the tube and the hoses from the anesthesia machine. (Figure 3) In addi-
Fig. 1- postoperative necrosis of skin over ala of nose.
have documented this problem in five cases, each of varying severity. In none of the cases was the defect permanent. (Figure 2)
Fig. 3-proper low profile with 1350 nasal adapter.
tion a"Vi-drape"" is used so that both the anesthesiologist and surgeon can observe the nasal tracheal tube4 throughout the procedure. (Figure 4) Visualizing the tube
Fig. 2- six weeks postoperatively showing healing. 'Chief Resident, Oral Surgery, Montefiore Hos-
pital and NMedical Center Bronx, N.Y. 2Chairman, Department of Dentistry and Oral Surgery, Montefiore Hospital and Medical Center, Bronx, N.Y.
MARcH-APRu., 1976
57
prevents undue pressure to the nose during the operation in addition to avoiding inadvertent extubation by the surgeon or assistant, (4) The tube is then stabilized with a tube tree,5 (5) Other methods of stabilizing endotracheal tubes have also been described.6-7-8 Using these modifications, adapting the length of the tube, stabilizing, and visualizing it eliminates this unusual complication of transient nasal skin necrosis.
@Foregger endotracheal adapter. "Spartan Surgi Film Surgical Drape.
2. VeIlacott, W. N. Nasal Intubation: Some postnasal obstructions and how they may be overcome. Brit J Anaesth 34:115, 1962.
3.
ewis, R. N., Swerdlov, M. Hazards of Endotrachael anesthesia. Brit J Anaesth 36:504, 1964.
4. Landsman, J. S., Allora, L. P. Surgical draping of the nasoendotracheal tube. JOS 33:628, 1975. 5. Evans, L. E. A versative accessory for stationing corrugated rebreather tubes during surgery. Anesth Prog 23:95, 1975. 6. Epstein, R A. A method of fixation of nasothracheal tubes in infants. Anesthes 33:458-459,
1970.
Bibliography 1. Anderson, J. C., Chow, A. E., Lindsay, W. A. Interstitial Emphysema of the Head and Neck. Anaesth 28:184-187, 1973.
7. Dykes, E. R, Anderson, R Technic for fixation of endotracheal tubes. Anesth Anaig 43:238, 1964. 8. Tahir, A, Adriani, J. A method for anchoring oral endotracheal tubes dunng pediatric anesthesia. Anesth Analg 50:314-315, 1971.
the ACE pulse-watch for accurate, efficient patient monitoring during surgical or dental procedure. ACE icorpoates the Wtest in Tle t ctonic tP_le-Watd o to cmte an accrate, reiairk, easy-to-use pus 'oatn devuce which the doctor or assitant to elctroaicsfy _able detemine - rate and rhytha Ti_s sfc, battery-operated debtronic u utties m electro-opticl pick-up pined on the tatiut's ieTe Duit is extmly eay to aSe, us ap the u-or dip onto the patats fngr ad it ecords the - rate on the uetter faen. In additiona, a voenr cotrol amde beep slows you to he both pe rate d rhythm. -at you want to kow - ps rate and inteast - annaiately wabe to you. AS it"s aR done by -m of the verY Wet sld sate inmteated cwrdis for extram mvy and relabiky.t Aceart puke rate in * Ope fom rebeats per n te 3 hou of coahotoeectric pick-up * on finger(Ear lobe & tiamos usage between e
-
a
AdMie beep for pu Frhym withvo*lue
Especially indicated for
use
0
with sedatio
control
Send for our latest catalog!
OAd
lcord
Complte Surical and Anesthesa neds. ---
IFm
eFimgerssr with
of meal senor dip
flm|f-
Ace Surgical Supply Company, Inc. 58
cjade * Seady ueter rendig no needle bourn
i
pr stree tockt
(4011sin -3100 ANESTFsiA PRoGREss
of
Nsl-Tracheal Anestesia
Michael E. Barkin, DDJS.1 and Norman Trieger, D.MD., MD.2
Nasal-tracheal intubation is commonly used for most head and neck procedures including dental and oral surgical operations. Various complications are reported in the literature, many of these deal with the mechanical diffculty of the nasal route.' 2'3 This report concerns a complication which is related to intra-operative trauma with subsequent postoperative necrosis of the skin over the ala of the nose. (Figure 1) We
In all cases, it is preventable with proper armamentarium. The two factors contributing to the necrosis was the position of the nasal tracheal tube and the length of the procedure. This complication has been eliminated in subsequent procedures of comparable length by ( 1) cutting the tube length as it exits the nose, (after successful intubation and confirming bilateral lung expansion and equal breath sounds), (2) A 1350 angle adapter' is placed in the tube insuring a low proffle, (3) A flexible connector is then used between the tube and the hoses from the anesthesia machine. (Figure 3) In addi-
Fig. 1- postoperative necrosis of skin over ala of nose.
have documented this problem in five cases, each of varying severity. In none of the cases was the defect permanent. (Figure 2)
Fig. 3-proper low profile with 1350 nasal adapter.
tion a"Vi-drape"" is used so that both the anesthesiologist and surgeon can observe the nasal tracheal tube4 throughout the procedure. (Figure 4) Visualizing the tube
Fig. 2- six weeks postoperatively showing healing. 'Chief Resident, Oral Surgery, Montefiore Hos-
pital and NMedical Center Bronx, N.Y. 2Chairman, Department of Dentistry and Oral Surgery, Montefiore Hospital and Medical Center, Bronx, N.Y.
MARcH-APRu., 1976
57
prevents undue pressure to the nose during the operation in addition to avoiding inadvertent extubation by the surgeon or assistant, (4) The tube is then stabilized with a tube tree,5 (5) Other methods of stabilizing endotracheal tubes have also been described.6-7-8 Using these modifications, adapting the length of the tube, stabilizing, and visualizing it eliminates this unusual complication of transient nasal skin necrosis.
@Foregger endotracheal adapter. "Spartan Surgi Film Surgical Drape.
2. VeIlacott, W. N. Nasal Intubation: Some postnasal obstructions and how they may be overcome. Brit J Anaesth 34:115, 1962.
3.
ewis, R. N., Swerdlov, M. Hazards of Endotrachael anesthesia. Brit J Anaesth 36:504, 1964.
4. Landsman, J. S., Allora, L. P. Surgical draping of the nasoendotracheal tube. JOS 33:628, 1975. 5. Evans, L. E. A versative accessory for stationing corrugated rebreather tubes during surgery. Anesth Prog 23:95, 1975. 6. Epstein, R A. A method of fixation of nasothracheal tubes in infants. Anesthes 33:458-459,
1970.
Bibliography 1. Anderson, J. C., Chow, A. E., Lindsay, W. A. Interstitial Emphysema of the Head and Neck. Anaesth 28:184-187, 1973.
7. Dykes, E. R, Anderson, R Technic for fixation of endotracheal tubes. Anesth Anaig 43:238, 1964. 8. Tahir, A, Adriani, J. A method for anchoring oral endotracheal tubes dunng pediatric anesthesia. Anesth Analg 50:314-315, 1971.
the ACE pulse-watch for accurate, efficient patient monitoring during surgical or dental procedure. ACE icorpoates the Wtest in Tle t ctonic tP_le-Watd o to cmte an accrate, reiairk, easy-to-use pus 'oatn devuce which the doctor or assitant to elctroaicsfy _able detemine - rate and rhytha Ti_s sfc, battery-operated debtronic u utties m electro-opticl pick-up pined on the tatiut's ieTe Duit is extmly eay to aSe, us ap the u-or dip onto the patats fngr ad it ecords the - rate on the uetter faen. In additiona, a voenr cotrol amde beep slows you to he both pe rate d rhythm. -at you want to kow - ps rate and inteast - annaiately wabe to you. AS it"s aR done by -m of the verY Wet sld sate inmteated cwrdis for extram mvy and relabiky.t Aceart puke rate in * Ope fom rebeats per n te 3 hou of coahotoeectric pick-up * on finger(Ear lobe & tiamos usage between e
-
a
AdMie beep for pu Frhym withvo*lue
Especially indicated for
use
0
with sedatio
control
Send for our latest catalog!
OAd
lcord
Complte Surical and Anesthesa neds. ---
IFm
eFimgerssr with
of meal senor dip
flm|f-
Ace Surgical Supply Company, Inc. 58
cjade * Seady ueter rendig no needle bourn
i
pr stree tockt
(4011sin -3100 ANESTFsiA PRoGREss
