Case 13: Where Are My Teeth?

Abstract

A 40-year-old man is scheduled for left ureteroscopic laser lithotripsy for nephrolithiasis. He is 90 kg and 5 ft 11 in. tall. His previous medical history is noncontributory. He had an uneventful hernia repair under general anesthesia 4 years ago. The anesthesia record mentioned no problem with endotracheal intubation. Examination of his airway reveals a maxillary anterior fixed partial denture. He informs you that they are “permanent.” He has had the bridge for 17 years and never caused any problems. After a routine induction of anesthesia, the patient is easily mask ventilated. A grade-1 view of the larynx is achieved with an atraumatic direct laryngoscope and an endotracheal tube (ETT) placed easily into the trachea. The rest of the anesthesia is uneventful. At the end of the surgery, the patient’s ETT is removed without any problems. He is transported to the postoperative care unit. Here, he experiences a bout of coughing. Upon becoming more alert, he says: “Where are my teeth?”