Preoperative chewing gum and foreign body airway obstruction

Abstract

suite, at 08.30 a.m., the patient denied any other intake. After the induction of anesthesia, direct laryngoscopy was performed and the patient’s trachea was intubated with a cuffed (7.5-mm) endotracheal tube, placed with the cuff below the level of the vocal cords. It was noted that the oropharynx was free from secretion and foreign bodies. The endotracheal tube was secured at 22 cm. Correct placement of the endotracheal tube was confi rmed by capnography and auscultation of breath sounds. Intraoperatively, there were no problems with excessive tachycardia, hypertension, bronchospasm, or regurgitation and pulmonary aspiration. The surgery proceeded uneventfully and ended successfully. After the end of the operation, during the emergence from anesthesia, the endotracheal tube was removed and, unexpectedly, the anesthesiologist observed that there was a chewing-gum mass adherent to the endotracheal tube (Fig. 1). Upon emergence from anesthesia, the patient claimed that nobody had told her not consume chewing gum and that she had used it to relieve her dry mouth and reduce anxiety. None of the nurses nor the anesthesiologist realized that the patient had been chewing gum preoperatively. The patient stayed in the recovery room for an hour and she did not complain of sore throat, dysphagia, or dysphonia. While most anesthesiologists, in accordance with American Society of Anesthesiologists (ASA) guidelines, are modifying