Document Detail

Combitube rescue for Cesarean delivery followed by ninth and twelfth cranial nerve dysfunction.
MedLine Citation:
PMID:  19138919     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The Combitube has been shown to be effective in many airway management scenarios. We describe its use as a rescue device in a "cannot intubate cannot ventilate" (CICV) situation that was encountered during a Cesarean delivery (CD) followed by transient cranial nerve dysfunction. CLINICAL FEATURES: A 24-yr-old gravida 4 para 1 (weight 112 kg, body mass index 44 kg.m(-2)) at 34 weeks gestation, with pregnancy induced hypertension and a prior history of uneventful airway management, presented for urgent CD. She refused regional anesthesia and attempts at awake laryngoscopy and intubation. Following rapid sequence induction, attempts at direct laryngoscopy and intubation failed. Ventilation via facemask and laryngeal mask also failed. A Combitube was inserted and inflated according to manufacturer's instructions and resulted in successful ventilation of the patient. The Combitube was in place for approximately three hours and then removed uneventfully. The following day, the patient presented with signs and symptoms consistent with bilateral glossopharyngeal and unilateral hypoglossal nerve dysfunction. Three months later the patient's nerve dysfunction had completely resolved. CONCLUSION: Although this patient's transient nerve dysfunction was most likely due to the Combitube, we believe its inclusion as part of any difficult airway armamentarium should be encouraged. Training in its use should be promoted. It has an important role in emergency airway management and can be effective when other non-surgical ventilation techniques fail. Despite this, clinicians must remain vigilant for complications following its use.
Jorge E Zamora; Tarit K Saha
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  55     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2009-01-13     Completed Date:  2009-02-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  779-84     Citation Subset:  IM    
Department of Anesthesiology, Queen's University, Kingston, Ontario K7L2V7, Canada.
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MeSH Terms
Anesthesia, Inhalation / adverse effects*
Anesthesia, Obstetrical / adverse effects*
Cesarean Section*
Glossopharyngeal Nerve / injuries*
Hypoglossal Nerve / injuries*
Intubation, Intratracheal / adverse effects*
Pharyngitis / etiology
Tongue / pathology
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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