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Warrick A, Backfish K, Bahadur SV. Sublingual Hematoma: A Rare Anesthetic Complication. Anesthesiology 2024:141891. [PMID: 39159304 DOI: 10.1097/aln.0000000000005147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Affiliation(s)
- Adam Warrick
- Indiana University School of Medicine, Department of Anesthesia, Indianapolis, Indiana
| | - Kevin Backfish
- Indiana University School of Medicine, Department of Anesthesia, Indianapolis, Indiana
| | - Sachin Vimal Bahadur
- Indiana University School of Medicine, Department of Anesthesia, Indianapolis, Indiana
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2
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Fritz CG, Monos SD, Romeo D, Lowery A, Xu K, Atkins J, Rajasekaran K. Medico-legal liability of injuries arising from laryngoscopy. J Laryngol Otol 2024; 138:554-558. [PMID: 37982243 PMCID: PMC11063656 DOI: 10.1017/s0022215123001986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Dental and mucosal injuries from laryngoscopy in the peri-operative period are common medico-legal complaints. This study investigated lawsuits arising from laryngoscopy. METHODS Westlaw, a legal database containing trial records from across the USA, was retrospectively reviewed. Plaintiff and/or defendant characteristics, claimed injuries, legal outcomes and awards were extracted. RESULTS Of all laryngoscopy-related dental or mucosal injuries brought before a state or federal court, none (0 per cent) resulted in a defence verdict against the provider or monetary gain for the patient. Rulings in the patient's favour were observed only when laryngoscopy was found to be the proximate cause of multiple compounding complications that culminated in severe medical outcomes such as exsanguination, septic shock or cardiopulmonary arrest. CONCLUSION Proper laryngoscopy technique and a robust informed-consent process that accurately sets patients' expectations reduces litigation risk. Future litigation pursuits should consider the low likelihood of malpractice allegation success at trial.
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Affiliation(s)
- Christian G Fritz
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
| | - Stylianos D Monos
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Dominic Romeo
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Anne Lowery
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
| | - Katherine Xu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Joshua Atkins
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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3
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Richtrova M, Koskova O, Marcian P, Joukal M, Musilova T, Janku M, Fabian D, Matyskova D, Stourac P. Use of computer-aided design and 3D printing for airway management in paediatric patients with a cleft facial defect: a pilot study. Br J Anaesth 2023; 130:e469-e471. [PMID: 36933955 DOI: 10.1016/j.bja.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Affiliation(s)
- Michaela Richtrova
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Olga Koskova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Paediatric Surgery, Orthopedics and Traumatology, University Hospital Brno, Brno, Czech Republic.
| | - Petr Marcian
- Faculty of Mechanical Engineering, Institute of Solid Mechanics, Mechatronics and Biomechanics, Brno University of Technology, Brno, Czech Republic
| | - Marek Joukal
- Faculty of Medicine, Department of Anatomy, Masaryk University Brno, Czech Republic; Department of Simulation Medicine of the Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tereza Musilova
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Brno, Czech Republic
| | - Martin Janku
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Simulation Medicine of the Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Dominik Fabian
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Brno, Czech Republic
| | - Dominika Matyskova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Paediatric Surgery, Orthopedics and Traumatology, University Hospital Brno, Brno, Czech Republic
| | - Petr Stourac
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Simulation Medicine of the Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Lakshminarasimman P, Pai PS, Mehta S, Patil P. Is Direct Laryngoscopy Obsolete? "Trans Nasal Oesophagoscopy" the Complete Endoscopic Solution in Head Neck Practice. Indian J Otolaryngol Head Neck Surg 2021; 73:310-314. [PMID: 34471618 DOI: 10.1007/s12070-021-02368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Abstract
Direct laryngoscopy (DL) is the standard of care for the evaluation of suspicious lesions in the larynx and hypo pharynx but requires general anaesthesia and a dedicated operation theatre. While DL offers us the ability to map the lesion adequately and take a biopsy, it requires workup for anaesthesia well as rigid oesophagoscopy for assessing the oesophagus with its associated complications. Sixty-nine patients underwent TNE under topical anaesthesia. The lesions were mapped and biopsies taken. Those patients who had an inadequate evaluation on TNE or negative biopsy underwent direct laryngoscopy. Completeness of evaluation, adequacy of biopsy, presence of synchronous oesophageal lesions and the modified Gloucester Comfort Score for patient comfort was documented. Amongst 69 cases enrolled for TNE evaluation, 97% of cases had an adequate mapping of disease extent, and 100% adequacy of biopsy material. General anaesthesia could be avoided in 92.75% of patients. TNE took a median time of 8 min. Synchronous oesophageal tumours were seen in 5.8% of patients. There were no complications and 74% patients did not experience any discomfort. TNE appears to be simple, safe, efficient office based diagnostic procedure. TNE has the potential to be the new standard of care making DL obsolete.
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Affiliation(s)
- P Lakshminarasimman
- Department of Head and Neck Surgery (Surgical Oncology), Sri Ramachandra Medical College and Research Institute, No. 1, Ramachandra Nagar, Porur, Chennai, 600116 India
| | - Prathamesh S Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, 400012 India
| | - Shaesta Mehta
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, 400012 India
| | - Prachi Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, 400012 India
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Doğan Ö, Altıntepe Doğan SS, Altıntepe N, Şahin ND, Çelik İH. An analysis of anesthetists' awareness, knowledge, and attitudes toward peri-anesthetic dental trauma. Dent Traumatol 2021; 37:786-794. [PMID: 34216178 DOI: 10.1111/edt.12702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Peri-anesthetic dental trauma is a common anesthesia-related complication. It is the reason for a significant number of malpractice lawsuits against anesthetists through insurance companies. The frequency, outcomes, and risk factors related to peri-anesthetic dental trauma have been well documented. The aim of this study was to evaluate anesthetists' awareness, knowledge, and attitudes toward peri-anesthetic dental trauma. MATERIAL AND METHODS This nationwide, cross-sectional, descriptive study comprising 220 anesthetists was conducted in Turkey between June 2019 and May 2020. A specific questionnaire was created using Google Forms and delivered to 591 participants via WhatsApp. Pearson's Chi-squared test and the Fisher-Freeman-Halton tests were used to analyze the results. RESULTS The overall response rate was 37.2% (220 out of 591 participants). Of the 80.5% of the participants who encountered peri-anesthetic dental trauma during their practice, 32.8% had encountered avulsion and 32.8% reported that they had caused soft tissue injuries. More than one-third of the participants (38.9%) stated that the patient group that was the most at-risk for peri-anesthetic dental trauma was older people with missing teeth. Half of the participants (50.9%) stated that avulsed teeth could be replanted; among them, 21.8% and 11.8% specified that the ideal replantation time was <30 min and that the ideal storage medium for the avulsed tooth was fresh milk, respectively. Furthermore, 88.1% of the participants noted that peri-anesthetic dental trauma occurred more frequently during emergency intubations and only 20.9% were aware of custom-made mouthguards. CONCLUSIONS Anesthetists lack knowledge around peri-anesthetic dental trauma and its interventions.
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Affiliation(s)
- Özgür Doğan
- Department of Pediatric Dentistry Afyonkarahisar, School of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Suat Serhan Altıntepe Doğan
- Department of Periodontology Afyonkarahisar, School of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Nihan Altıntepe
- Department of Anaesthesiology and Reanimation, Cemil Taşcıoğlu, City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Necibe Damla Şahin
- Department of Pediatric Dentistry Tokat, School of Dentistry, Tokat Gaziosmanpasa University, Afyonkarahisar, Turkey
| | - İsmail Haktan Çelik
- Department of Pediatric Dentistry Afyonkarahisar, School of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Ease of intubation and incidence of dental injury during direct laryngoscopy: A randomized controlled trial comparing five different laryngoscope blades (Macintosh, Miller, Reduce flange, Blechman and Flangeless). TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The gold standard in airway maintenance is translaryngeal endotracheal intubation, but this is not without its complications. Trauma to the upper airway as a result of the act of endotracheal intubation is a common event in adults undergoing procedures under general anaesthesia. Sites requiring attention during intubation include the laryngeal apparatus, the pharynx and oral cavity as well as the nasal cavity when nasopharyngeal intubation is performed. Patients can present with a range of symptoms which can make assessment and management challenging. Dysphonia, throat pain and dysphagia are the commonest presenting complaints. Patient-related factors, intubation technique and other anaesthetic-related conditions can be a cause of trauma, if not adequately considered before intubation. All patients should be carefully examined preoperatively and their past medical history obtained. Patient demographics, comorbidities, existing airway pathology and presence of reflux should be noted. Trauma prevention strategies should be in place to eliminate avoidable complications. Potential difficult airway cases should be flagged up and adequately prepared for, in anticipation of intubation difficulties that can lead to trauma. The majority of injuries will resolve spontaneously with conservative management. Persistent symptomatology, usually secondary to laryngeal injuries, requires prompt referral to an ear nose and throat specialist with an interest in laryngology for further assessment and treatment.
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Affiliation(s)
- Theofano Tikka
- ST5 Ear, Nose, Throat Registrar, Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow G51 4TN
| | - Omar J Hilmi
- Ear, Nose, Throat Consultant, Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow
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Lee SY, Bae SI, Do SH, Sohn JT, Park JW. The effect of brief pre-anesthetic exercise therapy of jaw and neck joints on mouth opening, neck extension, and intubation conditions during induction of general anesthesia: a randomized controlled trial. BMC Anesthesiol 2020; 20:28. [PMID: 31996130 PMCID: PMC6990593 DOI: 10.1186/s12871-020-0939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effort to improve tracheal intubation process is clinically valuable. We hypothesized that a preoperative brief exercise therapy would increase mouth opening and neck extension, enhancing intubation conditions during general anesthesia. METHODS Patients undergoing general anesthesia were randomized into two groups. The exercise group performed the exercise regimen including masseter muscle massage and stretching of jaw and neck joints before anesthetic induction, while the control did not. Before (baseline) and after the intervention, we evaluated Mallampati score, mouth aperture size, and sternomental distance. After tracheal intubation, intubation difficulty scale with direct laryngoscope and oropharyngeal soft tissue injury were also evaluated. RESULTS A total of 138 patients completed the analysis (control = 68, exercise = 70). Baseline characteristics did not differ between groups. At anesthetic induction, there was a significant difference in Mallampati score between the two groups (P = 0.039) and the incidence of Mallampati scores of 1 was higher in the exercise group (odds ratio [95% CI]: 2.1 [1.0-4.3], P = 0.043). Mouth opening after the intervention was greater in the exercise group than in the control group (estimated difference [95% CI]: - 2.4 [- 4.8 - -0.1], P = 0.042) and sternomental distance was similar between the two groups (estimated difference [95% CI]: - 3.7 [- 9.0-1.7, P = 0.175). The exercise group showed less soft tissue injuries (odds ratio [95% CI]: 0.2 [0.1-0.8], P = 0.009), however, intubation difficulty scale did not differ between the study groups (P = 0.112). CONCLUSIONS The brief pre-anesthetic exercise improved intubation conditions and enabled faster tracheal intubation with less injury to oropharyngeal soft tissue. TRIAL REGISTRATION Clinical Research Information Service (registration number: KCT0002618), registered at December 28, 2017.
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Affiliation(s)
- Sue Young Lee
- Department of Anesthesiology and Pain Medicine, ThanQ Seoul Thyroid-Head & Neck Surgery Center, Seoul, South Korea
| | - Sung Il Bae
- Department of Anesthesiology and Pain Medicine, Jinju Gyeongsang National University Hospital, Jinju, South Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ju-Tae Sohn
- Department of Anesthesiology and Pain Medicine, Jinju Gyeongsang National University Hospital, Jinju, South Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Jin-Woo Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea.
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Komasawa N, Komatsu M, Yamasaki H, Minami T. Lip, tooth, and pharyngeal injuries during tracheal intubation at a teaching hospital. Br J Anaesth 2018; 119:171. [PMID: 28974082 DOI: 10.1093/bja/aex184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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10
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Hewson DW, Hardman JG. Physical injuries during anaesthesia. BJA Educ 2018; 18:310-316. [PMID: 33456795 DOI: 10.1016/j.bjae.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- D W Hewson
- Anaesthesia & Critical Care, University of Nottingham, Nottingham, UK
| | - J G Hardman
- Anaesthesia & Critical Care, University of Nottingham, Nottingham, UK
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Sano H, Komasawa N, Konishi Y, Minami T. Evaluation of lip pulling method efficacy for direct laryngoscopy: A prospective crossover clinical pilot trial. J Clin Anesth 2017; 38:18-19. [DOI: 10.1016/j.jclinane.2017.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/07/2017] [Accepted: 01/10/2017] [Indexed: 11/28/2022]
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12
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Ueno T, Komasawa N, Nishihara I, Minami T. Lip injury associated with i-gel placement during general anesthesia. J Clin Anesth 2017; 38:24-25. [PMID: 28372668 DOI: 10.1016/j.jclinane.2017.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Takeshi Ueno
- Department of Anesthesiology, Osaka Medical College, Japan
| | | | - Isao Nishihara
- Department of Anesthesiology, Hokusetsu General Hospital, Japan
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Kharazmi M, Scheer H, Hallberg P. Reduced obstacles, maximized vision (ROMV): a new technique to facilitate laryngoscopy for endotracheal intubation. Ups J Med Sci 2017; 122:68-69. [PMID: 27849129 PMCID: PMC5361436 DOI: 10.1080/03009734.2016.1246494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Mohammad Kharazmi
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University SE-751 85 Uppsala, Sweden
- Department of Oral and Maxillofacial Surgery, Västmanland Hospital Västerås, SE-721 89 Västerås, Sweden
- CONTACT Mohammad Kharazmi, Section of Orthopaedics, Department of Surgical Sciences, Uppsala University SE-751 85 Uppsala, Sweden. E-mail:
| | - Håkan Scheer
- Department of Anaesthesiology and Intensive Care, Västmanland Hospital Västerås, SE-731 30 Västerås, Sweden
| | - Pär Hallberg
- Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
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Komasawa N, Mihara R, Kido H, Minami T. Possibility of lip pulling method not only for prevention of soft tissue injury but also for improved laryngoscopy and tracheal intubation. Am J Emerg Med 2016; 34:1694. [PMID: 27210729 DOI: 10.1016/j.ajem.2016.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
| | | | - Haruki Kido
- Department of Anesthesiology, Osaka Medical College
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