Pharyngeal perforation following endotracheal intubation in a patient with rheumatoid arthritis.

Abstract

Intubation of patients with rheuma­ toid arthritis (RA) can be difficult and airway trauma can occur with physical force and multiple attempts to intu­ bate. In one such patient, pharyngeal perforation, subcutaneous and medi­ astinal emphysema, pneumothorax and pneumoperitoneum occured following attemps of endotracheal intubation. Antibiotic therapy led to good results. Case Report A 63-year-old, 147 em tall woman weighing 50 kg was scheduled for to­ tal knee replacement. she had had RA since age 21. She complained of swal­ lowing disturbance as well as knee problem. At age 50, she was put un­ der general anesthesia for cholecystec­ tomy, at our hospital. A review of the anesthetic record at that time showed that endotracheal intubation was dif­ ficult and only after several attempts was success attained. Physical exami­ nation revealed slight deformity of ex­ tremities, but no limitation of cervical spine mobility. The mouth opening was about 3 fingers breadth. Premedication consisted of atropine,