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Chapter 28: Complications in Anesthesia

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Which of the following is the most common complication of nasotracheal intubation?

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(A) arytenoid dislocation

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(B) submucosal tear of the posterior pharyngeal wall

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(C) avulsion of the turbinate bone

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(D) epistaxis

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(E) esophageal perforation

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The answer is D. Abrasion of the nasal mucosa as the tube passes posteriorly can lead to epistaxis, the most common complication of nasal intubation. This usually occurs in the anterior aspect of the nasal septum, and is more likely to occur with larger tubes, use of excessive force, and/or repeated attempts. The use of vasoconstrictors has been shown in some studies to reduce the rate of epistaxis. One study estimated the rate of epistaxis to be approximately 17%, although most of these cases were not severe. Epistaxis is classified anatomically as either originating anteriorly or posteriorly. It is often difficult to determine.

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If bleeding is noted on insertion, some recommend to continue with the intubation, provided it can be completed quickly. This will serve to use the tube to tamponade the bleeding. If bleeding is brisk, the tube can be withdrawn slightly and the balloon inflated so that blood does not contaminate the oropharynx. In addition, while the balloon serves to tamponade the bleeding site, the tube lumen acts as a nasal airway. If bleeding continues, it can usually be controlled by the insertion of a bacitracin-coated absorbent tampon. Once placed, 10 mL of saline should be instilled in the nare (using a 22-guage angiocath) to speed the expansion of the tampon.

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Ref: Butterworth JF IV, Mackey DC, Wasnick JD. Morgan & Mikhail's Clinical Anesthesiology, 5th ed. New York, NY: McGraw Hill; 2013.

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Which of the following statements regarding sore throat following general anesthesia are TRUE?

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(A) The rates of sore throat for endotracheal tube (ETT) and laryngeal mask airway (LMA) are similar.

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(B) The most common injury attributed to the LMA is nerve palsy.

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(C) The incidence of sore throat is directly proportional to the size of the ETT.

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(D) High-volume, low-pressure cuffs are associated with a reduced incidence of sore throat.

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(E) Cuffed tubes lead to a greater incidence of sore throat than do uncuffed tubes.

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The answer is C. Sore throat is a common complaint after general anesthesia, affecting up to >10% of patients at 24 hours postoperatively. Up to 50% of patients who have their tracheas intubated with ETTs ...

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