Unanticipated difficult nasotracheal extubation following oral surgery

Nasotracheal intubation in patients with an unanticipated difficult airway--I.

To the Editor: We read, with interest, the recent case report written by Drs. Uria et al.1, and we agree with their assessment that it is important to perform a preliminary laryngoscopy prior to inserting a nasal tube. However, their recommendation to insert a bougie through the RAE® nasal tube, with its distal acute curve, can result in inappropriate bending of the distal portion which is unfa...

Yet another cause for difficult extubation of nasotracheal tube

Extubation strategy following difficult intubation.

Airway management relates to the period of tracheal intubation, maintenance of endotracheal tube in situ, and finally extubation. Problems related to difficult extubation still pose significant challenge for both anesthesiologists and intensivists. This article reviews current approach to extubation strategy following difficult intubation. Guidelines and algorithm may be helpful in order to ens...

Unanticipated admissions following ambulatory surgery

The principal causes of unanticipated admission to the ambulatory surgery unit at Viladecans Hospital between October 1990 and January 1997 were analyzed. Of 7006 patients who underwent outpatient surgery in our facility, 108 were admitted (1.54%). The mean age was 38 years and 93.5% were American Society of Anesthesiologists’ (ASA) physical status classification I and II. The principal reasons...

Difficult tracheal extubation.

We describe a case of nasotracheal tube fixation with a screw. A second case is described in which a broken drill bit was found to impinge on the wall but not penetrate into the lumen of a nasotracheal tube. Possible sequelae of this complication include airway leak, aspiration, tube obstruction, and trauma from attempts at forceful extubation. We recommend the routine intraoperative testing fo...