NM-225
Watch Out for the Eye: Fiber Optic Scope in the Trachea but cannot Advance the Endotracheal Tube
Mohammad S, Shoham D, Teima D, Jain R
University of Texas, Rosenberg, TX, USA
Nasotracheal intubation is common for dental procedures, and a fiber optic scope may be used to help guide the endotracheal tube (ETT) in a pediatric patient with a naturally more anterior airway compared to an adult. Though, complications can arise. In this case, a 3-year-old male presented for dental rehabilitation for dental caries. Induction of anesthesia was uneventful. The nare was subsequently sprayed with a nasal decongestant, and dilated with 16 Fr and 18 Fr nasal airways. A 4.0 nasal ETT was passed through the nare without difficulty. The pediatric fiber optic scope was then placed through the ETT. The vocal cords were visualized, and the fiber optic scope was advanced into the trachea. The ETT would not advance over the fiber optic scope easily even though the tip of the scope was in the trachea. A video laryngoscope (C-MAC) was then placed in the mouth to visualize why the ETT will not pass. It was then noted that the fiber optic scope had actually passed through the murphy eye of the ETT instead of the tip. The tip was more lateral and outside of the vocal cords. We found this to be an important clinical case since inadvertent injury could have occurred if proper steps were not taken.  If the ETT was forced over the fiber optic scope, terrible injury could have occurred to the vocal cords, arytenoids or other structures of the hypopharynx. We chose to not pass the ETT blindly and first visualize the tip via a fiber optic scope. From our database search, we were not able to find any publications regarding inadvertent placement of the fiber optic scope through the Murphy’s eye during intubation. A similar case was mentioned in a book; though, the patient was already intubated and was being examined with the fiber optic scope.1 Nonetheless, increased awareness for vigilance is needed to help prevent injury during intubation with a fiber optic scope.
References:
1. Macgillnray, R., & Odell, J. (1986). Eye to eye with Murphys law. Anaesthesia, 41(3), 334-334.
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