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Canadian Journal of Anesthesia

, Volume 55, Issue 11, pp 779–784 | Cite as

Combitube™ rescue for cesarean delivery followed by ninth and twelfth cranial nerve dysfunction

  • Jorge E. Zamora
  • Tarit K. Saha
Case Reports/Case Series

Abstract

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.

Keywords

Cesarean Delivery Laryngeal Mask Airway Airway Device Cricoid Pressure Rapid Sequence Induction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Opération de sauvetage avec un Combitube™ lors d’un accouchement par césarienne suivi d’un dysfonctionnement au niveau des neuvième et douzième nerfs craniens

Résumé

Objectif: Il a été démontré que le Combitube? peut être efficace dans de nombreux contextes de prise en charge des voies aériennes. Nous décrivons ici son utilisation comme appareil de sauvetage dans une situation où l’intubation et la ventilation sont impossibles (« cannot intubate cannot ventilate » — CICV) survenue pendant un accouchement par césarienne (AC) et suivie par un dysfonctionnement temporaire des nerfs crâniens.

Éléments cliniques: Une femme de 24 ans (G4, P1) (poids 112 kg, indice de masse corporelle 44 kg·m−2) à 34 semaines de grossesse, souffrant d’une hypertension provoquée par la grossesse et n’ayant pas d’antécédents de prise en charge des voies aériennes difficile, s’est présentée pour un AC urgent. Elle a refusé l’anesthésie régionale et les tentatives de laryngoscopie et d’intubation vigiles. À la suite de l’induction en séquence rapide, les tentatives de laryngoscopie et d’intubation ont échoué. La ventilation par masque facial et masque laryngé ont également échoué. Un Combitube a été inséré et gonflé selon les instructions du fabricant, résultant en une ventilation réussie de la patiente. Le Combitube est resté en place durant environ trois heures, puis a été retiré sans complication. Le jour suivant, la patiente a manifesté des signes et des symptômes compatibles avec une atteinte bilatérale des nerfs glossopharyngiens et unilatérale du grand hypoglosse. Trois mois plus tard, l’atteinte nerveuse de la patiente avait complètement disparu.

Conclusion: Bien que l’atteinte nerveuse temporaire de la patiente fut très probablement due au Combitube, nous pensons que l’inclusion de cet appareil dans l’arsenal thérapeutique de n’importe quelle prise en charge des voies aériennes difficile devrait être soutenu. La formation quant à son usage devrait être encouragée. Le Combitube joue un rôle important dans la prise en charge d’urgencedes voies aériennes et peut être efficace lorsque les autres techniques de ventilation non chirurgicales échouent. Malgré son utilité, les cliniciens doivent demeurer vigilants et attentifs aux complications qui peuvent survenir à la suite de son utilisation.

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Copyright information

© Canadian Anesthesiologists’ Society 2008

Authors and Affiliations

  1. 1.Department of AnesthesiologyQueen’s UniversityKingstonCanada

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