Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery

Abstract

A 64-year-old male had an awake right nasal fiber-optic intubation with an endotracheal tube for open reduction and internal fixation of bilateral displaced mandibular fractures. After induction of anesthesia, an 18 Fr nasogastric tube (NGT) was inserted through the left nostril and was secured. The patient required high flow rates to deliver adequate tidal volumes with the ventilator. A chest x-ray done in the postanesthesia care unit revealed a malpositioned NGT in the left lower lobe bronchus, which was immediately removed. The patient was extubated on postoperative day 2. Various traditional methods, such as aspiration of gastric contents, auscultation of gastric insufflations, and chest x-ray are in use to detect or prevent the misplacement of an NGT. These methods can be unreliable or impractical. Use of capnography to detect an improperly placed NGT should be considered in the operating room as a simple, cost-effective method with high sensitivity to prevent possibly serious sequelae of an NGT placed within the bronchial tree.

Intraoperative Gastric Tube Intubation: A Summary of Case Studies and Review of the Literature

“…Both misplacements were identified immediately and removed prior to incurring injury. Kavala et al reported an uncomplicated GT insertion, not recognized intra-operatively, that was endobronchially malpositioned diagnosed by chest x-ray in the post-anesthesia care unit [ 8 ]. The authors recalled difficulties with maintaining ventilation however were unable to discern the causative factor.…”

Eventos Adversos Relacionados À Sonda Enteral: Revisão Integrativa

“…Os dados sobre mau posicionamento de SE variam de 0,3 a 15% (40) . Entre os relatos mais frequentes no presente estudo, estão a inserção da SE em árvore brônquica e pulmão (34)(35)(36)(37)(38) e no cérebro (12,14,24,29) , enquanto a perfuração esofágica (26) , gástrica (11) , intestinal (25) e inserção da sonda em átrio (27) foram menos reportados. Em alguns casos, condições prévias do paciente contribuíram para essas intercorrências (11)(12)(13)25,27,29,34,52) , reforçando a (conclusão)…”