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

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...

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Bibliographic Details
Published in:Canadian journal of anesthesia 2008-11, Vol.55 (11), p.779-784
Main Authors: Zamora, Jorge E., Saha, Tarit K.
Format: Article
Language:English
Subjects:
Airway management
Anesthesia, Inhalation - adverse effects
Anesthesia, Obstetrical - adverse effects
Anesthesiology
Cardiology
Case Reports/Case Series
Cesarean Section
Critical Care Medicine
Female
Glossopharyngeal Nerve Injuries
Humans
Hypoglossal Nerve Injuries
Intensive
Intubation, Intratracheal - adverse effects
Medicine
Medicine & Public Health
Pain Medicine
Pediatrics
Pharyngitis - etiology
Pneumology/Respiratory System
Pregnancy
Tongue - pathology
Ventilation
Young Adult
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Summary: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.
ISSN:0832-610X
1496-8975
DOI:10.1007/BF03016352