A case of foreign body inhalation

Abstract

A 55-year-old man, having consumed a bottle of wine, presented having swallowed his denture. He had painful swallowing, was not managing his secretion load, and had moderate respiratory distress. A lateral neck radiograph was taken in the emergency department (Fig. 1), which confirmed the presence of a denture lodged within the pharynx at level C4–6 and partially overlying the laryngeal inlet. On review, some remaining anterior air space was seen that was thought to be passable from above. He had no other airway risk factors with the exception of now being edentulous! Aspiration risk dictated a preference to carry out airway management awake. Discussion was had with surgical colleagues that if the denture was dislodged by fibreoscopy and worsening airway obstruction ensued, then an awake surgical cricothyroidotomy would be required. The patient was prepared for this, and marked utilizing ultrasound before operation. Flexible fibreoscopy confirmed that the obstruction was negotiable and an awake fibreoptic intubation was carried out uneventfully with passage of a 5.5 reinforced tube. Subsequent management was uneventful. Extubation concern centred on the potential for trauma related airway swelling following removal of the dentures. A dose of 8 mg dexamethasone was given and the patient extubated without any issues. One further dose was prescribed prophylactically after operation and he was observed closely for 24 h. The associated MCQs (to support CME/CPD activity) can be accessed at www.access.oxfordjournals.org by subscribers to BJA Education. Predicting the difficult airwayBJA EducationVol. 15Issue 5PreviewThe difficult airway (DA) has been defined as ‘the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both’.1 A more complete definition would include airway instrumentation (e.g. with supraglottic airway devices), direct tracheal access, and consideration of the airway at extubation. Full-Text PDF Open Archive