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LETTER TO THE EDITOR

Penetrating Injury of the Soft Palate During GlideScope® Intubation

Department of Anesthesiology; Changhua Christian Hospital; Taiwan, Republic of China; 99792{at}cch.org.tw

To the Editor:

The GlideScope® system is a new videolaryngoscope. It has a digital camera incorporated into the blade, which displays a view of the pharyngeal and laryngeal structures on a dedicated monitor. This allows placement of a tracheal tube to be visualized. There are few major or special adverse events reported in the literature (1,2). We present an unusual case in which an unanticipated penetrating injury of the soft palate by the endotracheal tube occurred while intubating the trachea with the GlideScope®.

A 29-yr-old man was scheduled to undergo a rhinoplasty. Past history included a polypectomy; he denied any systemic disease. The patient’s head was positioned neutrally and a 7.5 cuffed endotracheal tube was angled with 60 degree curvature with the stylet. General anesthesia was induced with IV fentanyl and thiopental; succinylcholine was used. The GlideScope® was inserted in the midline; the uvula was identified and the epiglottis and vocal cords were displayed on the monitor. After advancing the tip of the endotracheal tube through the vocal folds, the stylet was withdrawn and the endotracheal tube passed through the trachea. The GlideScope® was withdrawn after visual confirmation of tracheal placement.

However, before the operation was completed, the surgeon checked the oral cavity for bleeding and found the endotracheal tube piercing the right soft palate (Fig. 1). No other trauma was found. After confirming that there was no bleeding from the soft palate, the endotracheal tube was removed. During 1-h follow up in the recovery room, there were no other complaints. The patient was discharged 3 days later without any untoward event.

View larger version (41K): [in this window] [in a new window]   Figure 1. Endotracheal tube penetrating the soft palate. U: uvula, SP: soft palate.

An intubation technique for the GlideScope® is recommended in the literature (3,4). However, while advancing the endotracheal tube from mouth to pharynx, the tip of the endotracheal tube that could potentially cause damage to soft tissue cannot be monitored on the screen of the GlideScope®. This report highlights the importance of directly watching the endotracheal tube before it appears on the monitor screen of the GlideScope®.

REFERENCES

1. Rai MR, Dering A, Verghese C. The Glidescope® system: a clinical assessment of performance. Anaesthesia 2005;60:60–4.[Web of Science][Medline]
2. Sun DA, Warriner CB, Parsons DG, et al. The GlideScope® video laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth 2005;94:381–4.[Abstract/Free Full Text]
3. Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope®) in 728 patients. Can J Anaesth 2005;52:191–8.[Web of Science][Medline]
4. Kramer DC, Osborn IP. More maneuvers to facilitate tracheal intubation with the GlideScope®. Can J Anaesth 2006;53:737.[Web of Science][Medline]

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