Anesth Prog. 2024 Sep 9;71(3):131-135. doi: 10.2344/862982.
Nasotracheal intubation can reveal unexpected findings like a foreign body in the airway. In such instances, expeditious decision-making is crucial to achieve ideal outcomes. This case report describes a petroleum jelly-based foreign body discovered in the nasopharynx during nasotracheal intubation and the subsequent airway management. A 64-year-old man with no prior history of adverse anesthetic events presented to an oral surgery office for extraction of teeth and placement of implants. While video laryngoscopy for nasotracheal intubation was performed, a blue foreign body was discovered inside the tip of the nasal endotracheal tube. Subsequent attempts to locate the source of the foreign body revealed in the nasopharynx a strip of blue gelatinous foreign body which was removed with suction. Due to the persistent presence of foreign body residues in the nasopharynx, orotracheal intubation was performed. Nasopharyngeal foreign bodies may elude even the most thorough preoperative medical history review and airway assessment. Therefore, it is reasonable for practitioners to ask explicitly about any foreign bodies in the nasal passages. Practitioners should become familiar with cognitive aids for relevant airway emergency management techniques and equipment for expeditious decision-making when unexpected foreign bodies are found.
经鼻气管插管可揭示气道内异物等意外发现。在这种情况下,迅速做出决策对于实现理想的结果至关重要。本病例报告描述了在经鼻气管插管过程中发现的鼻道内以凡士林为基质的异物,以及随后的气道管理。一名 64 岁男性,无不良麻醉事件史,因拔牙和植入物而前往口腔外科就诊。在进行视频喉镜经鼻气管插管时,发现鼻内导管尖端有一个蓝色异物。随后试图找到异物的来源,在鼻咽部发现一条蓝色胶状异物,用吸引器将其取出。由于鼻咽部仍有异物残留,行经口气管插管。即使进行了最彻底的术前病史回顾和气道评估,鼻咽部异物仍可能被遗漏。因此,让医生明确询问任何鼻腔内的异物是合理的。医生应该熟悉相关气道紧急管理技术的认知辅助工具,以及在发现意外异物时迅速做出决策所需的设备。