Anderson C E, Savignac A C
AANA J. 1991 Dec;59(6):538-40.
This case report discusses one of the unusual complications of nasoendotracheal intubation, amputation of the inferior turbinate with its subsequent impaction of the nasoendotracheal tube. A healthy 19-year-old male underwent surgery for an open reduction and internal fixation of a fractured mandible. Several minutes after nasoendotracheal intubation, airway pressures increased, end-tidal carbon dioxide levels increased, and the patient became difficult to ventilate. The patient was extubated and then reintubated with a smaller-diameter nasoendotracheal tube through the same naris without further sequelae. After examination the tube was found to be occluded with an inferior turbinate. The increased airway pressure and elevated carbon dioxide levels were early signs of partial airway obstruction. Capnography was an important early warning device to provide information prior to changes in other vital signs. It allowed rapid detection of a potentially disastrous obstruction of the airway before the patient experienced severe cardiopulmonary complications. These facts should assist the anesthetist in focusing attention on the possible obstruction of the airway with a foreign body after nasoendotracheal intubation.
本病例报告讨论了经鼻气管插管的一种罕见并发症，即下鼻甲截断并随后导致经鼻气管导管嵌塞。一名健康的19岁男性接受了下颌骨骨折切开复位内固定手术。经鼻气管插管几分钟后，气道压力升高，呼气末二氧化碳水平升高，患者通气困难。患者被拔管，然后通过同一鼻孔插入一根直径较小的经鼻气管导管重新插管，未出现进一步的后遗症。检查发现导管被下鼻甲堵塞。气道压力升高和二氧化碳水平升高是气道部分梗阻的早期迹象。二氧化碳描记法是一种重要的早期预警装置，可在其他生命体征发生变化之前提供信息。它能够在患者出现严重心肺并发症之前快速检测到潜在的灾难性气道梗阻。这些事实应有助于麻醉师将注意力集中在经鼻气管插管后气道可能被异物阻塞的情况上。
