Chewing gum: a potential cause of airway obstruction

Abstract

she was coughing and bucking, a small amount of gastric content present in the pharynx was quickly suctioned and the tube remained in place. Extubation was delayed for 5–10 min, until the patient became more alert, and could properly respond to verbal commands with a sustained head lift. Upon inspection of the tube, a piece of gum was found attached to the outside, above the cuff (Fig. 1). On questioning, the patient admitted to having swallowed chewing gum before being wheeled into the operating room. Chewing gum presents two problems for anesthesiologists: increased production of gastric fl uid volume, risking aspiration, and the risk of mechanical airway obstruction [1–3]. Gum in a tracheal tube or the upper airway is potentially lifethreatening. In our patient, silent regurgitation of the swallowed gum into the oral cavity from the esophagus or stomach during induction, rather than vomiting at emergence, was the most likely scenario. The chewing gum could have attached itself to the endotracheal tube upon intubation (more likely than upon extubation). The use of chewing gum before surgery should be prohibited. Although anesthesiologists readily accept that it must be included in the nil per os (NPO) rules [1], no clear preanesthetic guidelines currently exist. Patients will usually spit out gum before entering the operating room, but some, not aware of its risks and clinical implications, may swallow it. Patients should be asked specifi c questions, and care providers educated to the dangers. Chewing gum: a potential cause of airway obstruction