Patientin postoperativ: Wach, Orientiert, Keine Halsschmerzen, Übelkeit, Dysphagie oder Dysphonie. Auf Befragung, konnte sich nicht daran erinneren, ob sie den Kaugummi präoperativ auf der Fahrt ins Krankenhaus am morgen ausgespuckt hatte oder nicht....
Keiner im Team bemerkte dieses präoperativ (weder die Pflegende der Holding Area, noch die CRNA, noch der zuständige MD).
Fazit des Teams:
Einige Patienten betrachten Kaugummi nichts als Teil des NPO Regimes. Daher ist es sinnvoll spezifisch nach "non-nutritious" Produkten, wie z.B. Kaugummi zu fragen
WomBat, auch nüchtern!
Original:
Chewing Gum on a Laryngeal Mask AirwayT
Anesthesiology: Volume 97(6) December 2002 pp 1647-1648
Wenke, Mary C.R.N.A. (Certified Registered Nurse Anaesthesist)
Akça, Ozan M.D. (Medicinae Doctor = Doctor of Medicine)
University of Louisville, Kentucky, USA
We recently had a case that we would like to bring to the attention of
the anesthesia community. A 52-yr-old woman was admitted to our hospital
as an outpatient to have a right breast mass excised. Her American
Society of Anesthesiologists physical status was II; her Mallampati
airway score was also II. She reported ingesting nothing by mouth (NPO)
for more than 6 h. Her preoperative examination was unremarkable, other
than hypertension. The importance of being NPO was explained previously
by the surgeon's office, and it was reconfirmed during our preoperative
examination the morning of surgery. The patient volunteered that she had
not even drank water since midnight.
After a slow induction by propofol (2.5 mg/kg) and fentanyl (100 mcg),
the patient was intubated with a #4 disposable Laryngeal Mask Airway T
(LMA North America, Inc., San Diego, CA) on the first attempt with no
difficulties. The cuff of the Laryngeal Mask Airway T was inflated with
30 ml of air. After the intubation, a leak test was performed, and leak
pressure was recorded as 30 cm H2O. Anesthesia was maintained with 1
minimum alveolar concentration (MAC) desflurane for about 140 min in the
supine position with maximum of 23 cm H2O peak airway pressure to
provide approximately 700 ml tidal volume with assisted spontaneous
breathing. Flawless emergence of the patient was followed by the
extubation of the Laryngeal Mask Airway T. At that time, we discovered a
green gummy mass at the tip of the Laryngeal Mask Airway T. Other than a
slight dirty appearance on the inner surface of the Laryngeal Mask
AirwayT, nothing was out of the ordinary.
The patient was followed in the recovery room for an hour; she was fully
awake and oriented. She didn't complain of sore throat, nausea,
dysphagia, or dysphonia. When asked, she said that she was chewing a gum
on the way to the hospital, but couldn't remember whether she threw it
away before going into surgery. None of the holding-area nurses, the
nurse-anesthetist, nor the attending anesthesiologist (myself) realized
that the patient had been chewing gum preoperatively.
It appears that some patients do not consider chewing gum as a part of
their NPO status; therefore, it would be wise to question patients
specifically for nonnutritious products such as chewing gum.
Mary Wenke, C.R.N.A.
Ozan Akça, M.D.
© 2002 American Society of Anesthesiologists, Inc.