Another Source of Airway-leakage: Inadvertent Endobronchial Misplacement of Nasogastric Tube in a Patient Intubated with Double-lumen Endotracheal Tube under Anesthesia

手術中常以鼻胃管引流藉以改善腹部脹氣，增加手術視野的操作或減少術後腹部脹氣的併發症。有一些病人常要求在麻醉後置放鼻胃管；但少了病人吞嚥的配合和氣管插管後氣管內管對食道的壓迫影響，常導致麻醉後病人鼻胃管放置不易，或增加鼻胃管誤置於氣管內的可能性及併發症。我們報告一例使用雙腔氣管內管麻醉的病人，在鼻胃管置放後引發氣道漏氣，進而發覺並經支氣管鏡檢查證實鼻胃管誤置於右側支氣管內。該鼻胃管立刻拔除，氣道漏氣獲得改善；術後並藉由影像式喉頭鏡(Glide Scope)輔助順利重新放置鼻胃管。該病人術後恢復良好，沒有肺部併發症或喉頭創傷。我們進一步討論麻醉中病人置放鼻胃管時如何減少誤置氣管內的方法。

關鍵字

鼻胃管置放；術中併發症；雙腔氣管內插管

並列摘要

Nasogastric (NG) tube placement for gastrointestinal decompression is a common procedure for most major surgeries in the operating rooms. However, it could cause life-threatening complications in some difficult cases if it is not correctly placed in the stomach and recognition ofmisplacement is not prompt. We report a case of inadvertent endobronchial misplacement of NG tube in a patient intubated with double-lumen endotracheal tube for anesthesia. The NG tube slipped past the high-volume-low-pressure cuff of double-lumen endotracheal tube accidentally, resulting in airway-leakage and ventilatory failure. Traditional methods such as aspiration of gastric contents or auscultation of gastric insufflation air for confirmation are unreliable to exclude misplacement of NG tube. We suggest that using capnography to detectmisplacement of NG tube in the trachea or facilitating NG tube insertion by videolayrngoscope (Glide Scope) could be considered in the operating rooms to avoid complications.

並列關鍵字

Intubation, gastrointestinal: nasogastric tube ； Intraoperative complications ； Intubation, intratracheal ； double-lumen tube

國際替代計量

Another Source of Airway-leakage: Inadvertent Endobronchial Misplacement of Nasogastric Tube in a Patient Intubated with Double-lumen Endotracheal Tube under Anesthesia

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