The potential complications associa...

The potential complications associated with general endotracheal anesthesia administration are familiar to greatest in number perioperative nurses and other OR personnel everywhere their professional careers, perioperative fosters can expect to witness and assist with the resolution of a variety of anesthetic complications. This case research provides an account of a patient who experienced a single anesthetic complication that triggered a cascade of related complications and followed in a resuscitative event.

CASE COMMENTARY

Mr K a 38-year-old male weighing 370 lb (168 kg) and standing 5 ft 10 in (1778 cm) tall, underwent a horizontal mandibular advancement with a bilateral sagittal split osteotomy and LeFort I osteotomy advancement for treatment of obstructive rest apnea. Six months later, he bring to maturityed an infection associated with individual of the fixation screws in his left mandible, which manifested as a draining intraoral fistula and a small parulis (ie, gingival abscess) adjacent to teeth #18 and #19 Mr K was scheduled for surgical removal of his infected hardware and closure of the intraoral fistula.

After long consultation, Mr K's anesthesia care providers determined an anesthetic management plan for him that included an awake, fiber-optic nasal intubation because of Mr K's obesity, neck configuration, and mandibular pathology. Mr K was suggestioned about the plan and brought to the OR suite. As Mr K's physical size increased his risk of intraoperative injury from positioning, he was allowed to position himself comfortably upon the OR bed before the anesthesia care providers began preparing for administration of the topical anesthesia agents. Meticulous attention was taken to pad all Mr K's urgency points and secure him to the OR bed with multiple, extralong safety straps.

After the topical anesthetic agents were applied, the anesthesia care providers intubated Mr K nasally, via a fiber-optic bronchoscope pair attempts were required before correct placement of the endotracheal (ET) tube was verified capnographically and according to auscultation. Immediately after the tube was placed, Mr K who had been true calm and cooperative. became agitated and combative. Mr K was given a hem in and paper to communicate. He indicated, "I am having agitate breathing." Mr K's capnograph, oscillation oximetry, and auscultated lung fields continued to indicate legitimate tube placement, and the anesthesia care providers conclud that Mr K was experiencing anxiety related to the intubation and his inability to speak. Mr K was induced furtheir into general anesthesia with inhalational agents and paralytic medications. His vital signs were: measured [i]or[/i] regular beat 80, blood pressure 140/72, and oscillation oximetry 98%.

The mean fellow person and the oral and maxillofacial service (OMS) surgeon draped Mr K for the surgical deed After irrigating Mr K's oral cavity, the OM surgeon noted that Mr K had a submucosal placement of his ET tube in the fight oropharynx. Via direct laryngoscopy, the anesthesia care providers observ that the ET tube had been placed submucosally, exiting the mucosa superior to the esophagus and then passing into the trachea in a normal fashion (Figure 1)

An pressing consultation with the otorhinolaryngology surgeon was petitioned The otorhinolaryngologists advised the anesthesia care providers to withdraw the submucosally placed tube and to reintubate Mr K via his oral cavity. mattered with possible upper airway obstruction, the anesthesia care providers passed an intubating poniard through Mr K's nasal tube into his trachea for use as a ventilation port with a high-frequency jet ventilator. The anesthesia care providers remov Mr K's nasal ET tube. and Mr K was oxygenated, via the jet ventilator, from one side the remaining intubating stylet. Although difficult because of developing laryngeal edema, an ET tube was introduced favorably into Mr K's trachea, alongside the intubating specillum At this point, the anesthesia care providers began to experience difficulty in ventilating Mr K His peak squeezings began to increase, and his oxygen saturation began to decrease. The anesthesia care providers continued to use the jet ventilator to oxygenate Mr K while the perioperative encourages and otorhinolaryngologists prepared to perform an necessity tracheostomy.

The tracheostomy was complet using a large (ie, size #8) tracheostomy tube. During placement of the tracheostomy tube, the anesthesia care providers continued to use the jet ventilator to aid Mr K's respiration. The anesthesia care providers conjoined Mr K's tracheostomy tube to the anesthesia machine circuit and ventilator.

Mr K continued to exhibit steadily increasing peak presss decreasing oxygen saturation levels, and ventilatory difficulty. forward bilateral chest auscultation, breath goods were not present over his left lung fields. Decreased breath goods also were noted over the right lung fields. In addition, the heart tones from one side of to the other the left lung fields were somewhat muffl An strait intraoperative chest x-ray was taken. The x-ray indicated a right tracheal deviation and a left pneumothorax.