Anesth Analg 2004;99:622
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000130908.00901.A2
LETTERS TO THE EDITOR
A Well-Fertilized Bulb Should Blossom
Timothy E. Smith, MD,
Daniel d’Hulst, MD, and
Douglas G. Ririe, MD
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC
To the Editor:
Tracheal aspiration of a foreign body is a well-known concern during the perioperative period. This occurs most commonly in patients with loose teeth, poor dentition, and/or dental prosthetics. Fortunately, aspiration of equipment or pieces of equipment is rare. We report an iatrogenic ingestion from anesthesia equipment in a pediatric patient that has direct impact on the practice of anesthesia and potential for associated morbidity. Although this has been reported in the pediatric literature (1–3), it has not been reported in the anesthesiology journals.
A 17-year-old male patient with complex congenital heart disease was scheduled to undergo cardiac catheterization under general anesthesia to facilitate right internal jugular (RIJ) cannulation, control FIO2, ventilation, and the potential delivery of nitric oxide for pulmonary hypertension. After induction of general anesthesia, tracheal intubation was accomplished with direct laryngoscopy. However, the laryngoscope light "went out," and was considered an irritation with no apparent consequence. Approximately 20 min later, the bulb on the laryngoscope blade was noted to be missing. By this time, the neck was fully prepped and draped, and the cardiologist was attempting RIJ cannulation. Fluoroscopy demonstrated the laryngoscope bulb in the patient’s hypopharynx (Fig. 1). Due to the work in process and the presence of the sterile field, we decided to wait and remove the bulb under direct laryngoscopy at the end of the procedure. However, at the end of the procedure, the bulb could not be found by direct laryngoscopy. Fluoroscopy revealed the bulb in the patient’s stomach (Fig. 2).
This case underscores the need to verify the integrity of any equipment used in or on a patient. Nowhere is this more critical than when working in and around the airway where the potential for catastrophic airway problems from aspiration of foreign bodies can occur. As such, we remind our colleagues to check the integrity of the airway equipment prior to use, particularly the bulb on the laryngoscope blade!
In this case, good fortune played a role in the outcome in that the incident was recognized, no airway problem was noted, and the bulb ended up being ingested and not aspirated. The patient and family were advised of the event and informed that the "planted and fertilized" bulb should "bloom" in the next few days. The bulb subsequently blossomed without incident.
References
- Naumovski L, Schaffer K, Fleisher B. Ingestion of a laryngoscope light bulb during delivery room resuscitation. Pediatrics 1991; 87: 581–2.[Abstract/Free Full Text]
- Ince Z, Tugcu D, Coban A. An unusual complication of endotracheal intubation: ingestion of a laryngoscope bulb. Pediatr Emerg Care 1998; 14: 275–6.[Web of Science][Medline]
- Delport SD, Gibson BH. Ingestion of a laryngoscope light bulb during tracheal intubation. S Afr Med J 1992; 81: 579.[Web of Science][Medline]
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