The oropharyngeal bleeding after esophageal stethoscope insertion: A case report

The daily insertion of endotracheal tubes, laryngeal mask airways, oral/nasal airways, gastric tubes, transesophageal echocardiogram probes, esophageal dilators and emergency airways all involve the risk of airway structure damage. In the closed claims analysis of the American Society of Anesthesiologists, 6% of all claims concerned airway injury. Among the airway injury claims, the most common cause was difficult intubation. Among many other causes, esophageal stethoscope is a relatively noninvasive monitor that provides extremely useful information. Relatively not many side effects that hardly is ratable. Some of that was from tracheal insertion, bronchial insertion resulting in hypoxia, hoarseness due to post cricoids inflammation, misguided surgical dissection of esophagus. Also oropharyngeal bleeding and subsequent anemia probably are possible and rarely pharyngeal/esophageal perforations are also possible because of this device. Careful and gentle procedure is necessary when inserting esophageal stethoscope and observations for injury and bleeding are needed after insertion.

Does the Esophageal Stethoscope Inserted into the Reinforced Endotracheal Tube Decrease the Incedence of Nasal Bleeding following Nasotracheal Intubation? / 대한마취과학회지

BACKGROUND: Conventional nasotracheal intubation is commonly associated with injury to the passage tissues, such as the mucosal lining of the turbinates. Nasal polyp, teared mucosa and blood clots are potentially hazardous, since it lodge in a bronchus or obstruct a tracheal tube. So atraumatic intubation is very important point during nasotracheal intubation. METHODS: Fourty patients were divided into two groups, Mallinckrodt reinforced tube(n=20) and esophageal stethoscope inserted into the Mallinckrodt reinforced tube(n=20). The esophageal stethoscope was inserted into the Mallinckrodt reinforced tube until the distal end of the esophageal stethoscope reached about 5 mm beyond the distal end of the Mallinckrodt tube. The esophageal stethoscope was inflated using an air-filled syringe through a three-way stopcock. After defasciculating dose of pancuronium 0.5~1 mg intravenously, the patients were given thiopental 4~5 mg/kg, succinylcholine 1~2 mg/kg and lidocaine 1.5 mg/kg with 100% oxygen ventilation via face mask. After lubrication of the appropriate tracheal tube with jelly, it was gently advanced beyond the nasopharynx. The tube tip was manipulated into the larynx with the aid of a Magill intubating forceps. The incidence of epistaxis was compared between the two groups. RESULTS: The esophageal stethoscope inserted into the reinforced tube group had a significantly lower incidence of nasal bleeding than reinforced tube only (1/20 vs 18/20 : P<0.01). CONCLUSIONS: The esophageal stethoscope inserted into the reinforced endotracheal tube helps to minimize nasal bleeding during nasotracheal intubation.