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Pediatric Airway Scope Is Available for Gastric Tube Insertion in Adult Patients
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LETTERS TO THE EDITOR
5. Perkins GD, Woollard M, Cooke MW, et al: Prehospital randomised assessment of a mechanical compression device in cardiac arrest (paramedic) trial protocol. Scand J Trauma Rescue Emerg Med 5:18-58, 2010
http://dx.doi.org/10.1053/j.jvca.2012.03.015
Pediatric Airway Scope Is Available for Gastric Tube Insertion in Adult Patients To the Editor: In our anesthetic management of coronary artery surgery, gastric tube (GT) insertion is a routine practice after intubation. Occasionally, a small mucosal injury caused by the blind insertion of a GT (including postcricoid ulceration and vocal cord paralysis1) may induce massive hemorrhage because of the systemic administration of heparin during cardiac surgery. To avoid this complication, the GT insertion preferably should be performed under visual control during the GT advancement. Until recently, most visualization devices, including the Airway Scope (AWS; Pentax-AWS, Hoya, Tokyo, Japan), limited the oropharyngeal manipulations because narrowing of the oropharyngeal space by the endotracheal tube interferes with the advancement of the laryngoscope and decreases visibility of the posterior larynx. Recently, a new AWS blade for children, which is smaller than that for adults, has been made available for pediatric
endotracheal intubation. This blade also can pass through a narrow upper airway and visualize the hypopharynx in adult anesthetized, endotracheally intubated patients. We report the use of this new pediatric blade for the insertion of the GT in an endotracheally intubated adult patient. A 73-year old woman (height, 1.71 m; weight, 53.1 kg) was scheduled to undergo cardiac surgery. After anesthesia induction and paralysis, the trachea was intubated with an 8.0-mm internal diameter orotracheal tube. For oral insertion of the GT, a 16 F, 122 cm, Argyle Salem Sump tube (Coviden, Dublin, Ireland) was attached to the main channel of the pediatric blade of the AWS (Fig 1). The pediatric blade was placed smoothly into the oral cavity and advanced to the hypopharynx. When a good view of the hypopharynx was obtained, the GT was advanced under the arytenoid cartilage through the inlet of the esophagus and introduced into the stomach. No mucosal injury or bleeding was noted during withdrawal of the blade. Successful placement of the GT was checked by aspiration of the gastric juice using vacuum suction. Ikeno et al2 reported that the AWS facilitated GT placement in anesthetized patients. The AWS blade for adults might be placed between the endotracheal tube and the epiglottis. In such cases, a view of the hypopharynx, including the inlet of the esophagus, cannot always be obtained. Therefore, a small and compact pediatric blade is more suitable for oropharyngeal manipulations and viewing of the hypopharynx. Hirotoshi Kitagawa, MD, PhD* Yasuhiko Imashuku, MD* Toji Yamazaki, MD, PhD† *Department of Anesthesiology Shiga University of Medical Science Shiga, Japan †Department of Anesthesiology National Hospital Organization Kinki-Chuo Chest Medical Center Osaka, Japan REFERENCES 1. Brousseau VJ, Kost KM: A rare but serious entity: Nasogastric tube syndrome. Otolaryngol Head Neck Surg 135:677-679, 2006 2. Ikeno S, Nagano M, Tanaka S, et al: Gastric tube insertion under visual control with the use of the Pentax-AWS. J Anesth 25:475-476, 2011 http://dx.doi.org/10.1053/j.jvca.2012.03.018
Stress-Induced Cardiomyopathy After Patent Foramen Ovale Closure: What Role Did Anesthesia Play? To the Editor: Fig 1. The nasogastric tube (GT) was advanced under the arytenoid cartilage (A) using the pediatric blade of the Airway Scope (AWS-PB). T, trachea. (Color version of figure is available online.)
Stress-induced cardiomyopathies make up a heterogenous group of disorders for which pathogenesis seems to be attributed to the cardiac injury generated by an excess of
LETTERS TO THE EDITOR
5. Perkins GD, Woollard M, Cooke MW, et al: Prehospital randomised assessment of a mechanical compression device in cardiac arrest (paramedic) trial protocol. Scand J Trauma Rescue Emerg Med 5:18-58, 2010
http://dx.doi.org/10.1053/j.jvca.2012.03.015
Pediatric Airway Scope Is Available for Gastric Tube Insertion in Adult Patients To the Editor: In our anesthetic management of coronary artery surgery, gastric tube (GT) insertion is a routine practice after intubation. Occasionally, a small mucosal injury caused by the blind insertion of a GT (including postcricoid ulceration and vocal cord paralysis1) may induce massive hemorrhage because of the systemic administration of heparin during cardiac surgery. To avoid this complication, the GT insertion preferably should be performed under visual control during the GT advancement. Until recently, most visualization devices, including the Airway Scope (AWS; Pentax-AWS, Hoya, Tokyo, Japan), limited the oropharyngeal manipulations because narrowing of the oropharyngeal space by the endotracheal tube interferes with the advancement of the laryngoscope and decreases visibility of the posterior larynx. Recently, a new AWS blade for children, which is smaller than that for adults, has been made available for pediatric
endotracheal intubation. This blade also can pass through a narrow upper airway and visualize the hypopharynx in adult anesthetized, endotracheally intubated patients. We report the use of this new pediatric blade for the insertion of the GT in an endotracheally intubated adult patient. A 73-year old woman (height, 1.71 m; weight, 53.1 kg) was scheduled to undergo cardiac surgery. After anesthesia induction and paralysis, the trachea was intubated with an 8.0-mm internal diameter orotracheal tube. For oral insertion of the GT, a 16 F, 122 cm, Argyle Salem Sump tube (Coviden, Dublin, Ireland) was attached to the main channel of the pediatric blade of the AWS (Fig 1). The pediatric blade was placed smoothly into the oral cavity and advanced to the hypopharynx. When a good view of the hypopharynx was obtained, the GT was advanced under the arytenoid cartilage through the inlet of the esophagus and introduced into the stomach. No mucosal injury or bleeding was noted during withdrawal of the blade. Successful placement of the GT was checked by aspiration of the gastric juice using vacuum suction. Ikeno et al2 reported that the AWS facilitated GT placement in anesthetized patients. The AWS blade for adults might be placed between the endotracheal tube and the epiglottis. In such cases, a view of the hypopharynx, including the inlet of the esophagus, cannot always be obtained. Therefore, a small and compact pediatric blade is more suitable for oropharyngeal manipulations and viewing of the hypopharynx. Hirotoshi Kitagawa, MD, PhD* Yasuhiko Imashuku, MD* Toji Yamazaki, MD, PhD† *Department of Anesthesiology Shiga University of Medical Science Shiga, Japan †Department of Anesthesiology National Hospital Organization Kinki-Chuo Chest Medical Center Osaka, Japan REFERENCES 1. Brousseau VJ, Kost KM: A rare but serious entity: Nasogastric tube syndrome. Otolaryngol Head Neck Surg 135:677-679, 2006 2. Ikeno S, Nagano M, Tanaka S, et al: Gastric tube insertion under visual control with the use of the Pentax-AWS. J Anesth 25:475-476, 2011 http://dx.doi.org/10.1053/j.jvca.2012.03.018
Stress-Induced Cardiomyopathy After Patent Foramen Ovale Closure: What Role Did Anesthesia Play? To the Editor: Fig 1. The nasogastric tube (GT) was advanced under the arytenoid cartilage (A) using the pediatric blade of the Airway Scope (AWS-PB). T, trachea. (Color version of figure is available online.)
Stress-induced cardiomyopathies make up a heterogenous group of disorders for which pathogenesis seems to be attributed to the cardiac injury generated by an excess of