Nasal Spur Causing Permanent Damage to Intubating Video Bronchoscope

[摘要] Sir, Awake fiberoptic intubation (AFOI) is considered the gold standard for securing the airway in patients with anticipated difficult airway. Although various new devices such as videoscopes have been introduced which greatly reduced the use of flexible bronchoscope, in patients with restricted mouth opening AFOI is considered the safest technique. We are reporting an incident which caused permanent damage to the Karl Storz intubating video bronchoscope which has been in use only for about a month. A 54-year-old male patient, with a case of carcinoma alveolus, was posted for wide local excision and neck dissection who had a limited mouth opening of 1cm. Neck movements were adequate. The plan was awake flexible bronchoscope-assisted nasal intubation. The left nostril was chosen since it appeared more patent. The nose was decongested and tropicalized with lignocaine 10% spray and 2% jelly. Transtracheal block was given with 4mL of 2% lignocaine. The passage of bronchoscope through the airway appeared smooth. When the endotracheal tube (ETT) was railroaded over bronchoscope some resistance was encountered at the nose. But we were able to pass ETT down without undue force. The patient was induced, paralyzed, and connected to the ventilator. At that time, a leak in the ETT cuff was noticed. A fresh ETT was exchanged for the faulty one over a tube exchanger and the surgery went on uneventfully. The intubation was performed by a senior anesthetist well experienced in performing FOI. At this time, no damage to bronchoscope was noticed as we did not suspect it. The scope was cleaned and the flexible part was put in glutaraldehyde solution for 20 min for sterilizing. Later, it was found that the image was not being captured. An external examination did not reveal obvious damage. The scope was inspected the next day by a company person who detected a clean cut (approximately 2 mm) in the sheath about 2.5 cm above the distal tip of the scope. The leak was demonstrated using a hand-held pressure tester also. We went back and looked at the computed tomography (CT) scan of the nose of the patient and found a sharp projection at the cartilage bony junction in the left nasal cavity in the coronal section [Figure 1]. In all likelihood, the scope would have passed through this space considering the hypertrophic inferior turbinate. It was assumed that water and glutaraldehyde solution would have leaked in and damaged the electronic image sensor (CMOS sensor) located at the distal end of the bronchoscope. We did not foresee this problem as we have never encountered such an issue before.Figure 1: CT coronal view showing nasal spur.

[学科分类] 皮肤病学