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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 188-189

Nasal spur causing permanent damage to intubating video bronchoscope


Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Date of Submission16-Oct-2022
Date of Acceptance10-Nov-2022
Date of Web Publication15-Dec-2022

Correspondence Address:
Sunil Rajan
Department of Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jhnps.jhnps_74_22

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How to cite this article:
Paul J, Rajan S, Sasikumar NK, Kumar L. Nasal spur causing permanent damage to intubating video bronchoscope. J Head Neck Physicians Surg 2022;10:188-9

How to cite this URL:
Paul J, Rajan S, Sasikumar NK, Kumar L. Nasal spur causing permanent damage to intubating video bronchoscope. J Head Neck Physicians Surg [serial online] 2022 [cited 2023 Feb 1];10:188-9. Available from: https://www.jhnps.org/text.asp?2022/10/2/188/363932



Sir,

Awake fiberoptic intubation (AFOI) is considered the gold standard for securing the airway in patients with anticipated difficult airway.[1] Although various new devices such as videoscopes have been introduced which greatly reduced the use of flexible bronchoscope,[2] 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.

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Nasal spurs are known to damage fiberoptic bronchoscopes.[3] Prior video rhinolaryngoscopy can pick it up early, if available.[4] Most difficult airway patients having either head-and-neck cancers or ankylosis of the temporomandibular joint might have taken either CT or magnetic resonance imaging of the head-and-neck region for assessment of the extent of the disease. It is concluded that in patients requiring nasal FOI, looking for the presence of nasal spur in the already available radiological images could be a good practice to avoid similar incidents.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Disclosure

This material has never been published and is not currently under evaluation in any other peer-reviewed publication.

Ethical approval

The permission was taken from the Institutional Ethics Committee before starting the project. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Acknowledgement

The authors are thankful to the participants who generously participated in the study.



 
  References Top

1.
Wong J, Lee JS, Wong TGL, Iqbal R, Wong P. Fibreoptic intubation in airway management: A review article. Singapore Med J 2019;60:110-8.  Back to cited text no. 1
    
2.
Alhomary M, Ramadan E, Curran E, Walsh SR. Videolaryngoscopy vs. fibreoptic bronchoscopy for awake tracheal intubation: A systematic review and meta-analysis. Anaesthesia 2018;73:1151-61.  Back to cited text no. 2
    
3.
Kahraman H, Sagiroglu S, Arpağ H, Atilla N. Damage to a fiberoptic bronchoscope due to nasal septal deformity. Respir Case Rep 2018;7:131-3.  Back to cited text no. 3
    
4.
Sinha C, Nanda S, Kumar A, Kumari P. Nasal assessment for nasotracheal intubation: A ray of hope. J Anaesthesiol Clin Pharmacol 2018;34:258-9.  Back to cited text no. 4
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