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Kaugummi auf der Larynx Maske

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    Kaugummi auf der Larynx Maske

    Kurzfassung: Fallbeispiel einer Frau zur Excision einer "Masse" der re. Brust; keine Besonderheiten bei der präop Untersuchung außer Hypertension. Laut eigener Angabe, war die Frau seit Mitternacht nüchtern. Narkoseeinleitung mit Propofol, Fenta, problemlose Intubation mit 4er LM, problemlose Beamtmung + ASB, problemloses Erwachen und Extubation. Dabei findet das Team eine grüne, gummiartige Masse auf der Spitze der LM.
    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.
    Pflegefachkräfte sind nicht teuer, sie sind unbezahlbar!
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